Failing to adopt widely available billing and collections technology can cost medical practices big in lost productivity, slow reimbursement, and underpayments. Too often we see practices focus on implementing an EHR; yet their billing staff are struggling through inadequate use of financial technology. Use the checklist below to determine if your billing office is using all the available tools to ensure the fastest reimbursement possible for your practice.
1. Electronic Funds Transfer (EFT)
Instead of receiving a paper check in the mail, payments from payers can be securely transferred to your practice's bank account using electronic funds transfer. There is no cost to enroll and most major payers offer this service. Blue Cross Blue Shield of Illinois, New Mexico, and Texas, for example, offer daily payment options when enrolling in EFT. Using EFT reduces the number of checks your staff will have to deposit and also provides better audit control.
2. Remote Deposit Capture (RDC)
Electronic funds transfer will significantly reduce the number of insurance checks flowing to the office; however, there remain check payments from patients. For those checks, use remote deposit capture (RDC) — a scanner that converts a paper check into an automated clearing house (ACH) transaction and deposits funds into the practice's bank account. There is a monthly fee and also a per-transaction fee associated with RDC, but the time savings (not having to complete a deposit slip and physically going to the bank) produces a significant return on investment for most practices. Most banks and credit card vendors offer RDC.
3. Electronic Remittance Advice (ERA)
Electronic remittance advice is the single most effective tool in reducing time spent in the billing office. Rather than manually keying data from an explanation of benefits (EOB), an electronic file is received from the payer and auto-posted. The process is coordinated through your claims clearinghouse. This allows billers to focus on following up unpaid claims, rather than tedious data entry.
4. Electronic Filing of Workers' Comp Claims
Another game changer in recent years is the ability to electronically file workers' compensation claims, even if you do not have an EHR. This is a significant time saver; eliminating the need to print the claim, attach the notes, and then mail it. Clearinghouses are also able to electronically file secondary claims that do not automatically cross over, as long as you have ERA. This eliminates the very laborious process of using a black marker to de-identify other patients on an EOB.
5. Batch Eligibility
Virtually all practice management systems or clearinghouses have the capability to verify the insurance of scheduled patients; yet, we find few practices use this technology or only use it for select patients. Preregister all patients and allow your PM system to verify insurance in advance of appointments to reduce denials for "coverage not effective at date of service." Often, information about unmet deductibles for in-network providers and copay amounts can be returned as well — providing valuable tools for collection at the time of service.
6. Cost Estimators
A growing number of payers are offering cost estimators on their websites. This is an invaluable tool for practices to provide an estimate to patients based on CPT code(s) during financial counseling, and an aid in collecting patient copays and deductibles prior to a non-emergency procedure.
7. Analyzing Underpayments
How does your billing office know that you are being paid according to contract? Too often they don't know, and practices leave significant money on the table. Many practices are able to upload payer fee schedules directly into their PM system and, on a per transaction basis, compare the payment amount to the contract amount — or run exception reports. Practices can take a more sophisticated approach by using software programs to analyze underpayments. There are third party applications available at reasonable costs that analyze underpayments, and allow you to appeal those underpayments.
Cheyenne Brinson, MBA, CPA, is a practice management consultant and speaker with KarenZupko & Associates who helps physician practices build solid internal controls, reduce overhead, and increase revenue. She can be reached at [email protected].