Complete the “Electronic Claims” process.
Most practices have embraced electronic claims filing and are realizing significant benefits by reducing filing errors, saving staff time and dramatically improving turnaround time for payment.
There are two other steps in the “Electronic Claims” process that should be seriously considered: Electronic Remittance Advice files (ERA) and Electronic Funds Transfer (EFT).
Medicare says the following about EFT and ERA:
“[Medicare] recommends that providers accept ERA transmissions in lieu of mailed SPRs [EOBs], and that they accept EFT payments rather than paper checks. The amount payable for each claim as well as each adjustment applied to a claim can be automatically posted from an ERA, eliminating the time and cost for staff to post this information manually from an SPR. ERAs generally contain more detailed information that there is not space to report on an SPR. SPRs do not contain any information that is not available on an ERA, and where the same fields are reported on an SPR as in an ERA, the information in those fields is identical.” *
Stop unnecessary Manual Data Entry – When you file claims electronically (and even if you file on paper) Electronic Remittance Advice (ERA) files are available from nearly all payers. These files can easily be obtained from a clearinghouse or directly from the insurance company. Payers have different requirements for the application. Many require an original signature of the provider though some provide for the application process to be completed online. Most clearinghouses assist their customers in this process. It pays to do some research before making a commitment to a clearinghouse. As always, there are tradeoffs in cost versus service to be considered.
Receiving ERA files eliminates waiting for printed EOBs to arrive via the mail service. An EOB can be printed from the ERA file immediately upon its arrival in your office computer. All information currently on a printed EOB is available in the ERA. Additional information* that can be of significant value to a practice in managing its claims processing, is also available in the ERA files.
An EOB can be printed from an ERA file in a number of ways. Things to watch for when selecting software to print the ERA include: will it accept ALL ERA files or is it limited to Medicare or some subset of the huge number of payer provided ERA files; does it allow automatic posting of the ERA as well as printing; will it print a standard EOB format regardless of the source of the ERA?
It is particularly important to be aware that many payers will cease distribution of the printed EOB when a practice begins to receive the ERA files electronically. This usually occurs within 45 days but payers may differ in their management of this option.
Cash in the Bank - Tired of waiting for “the checks in the mail!” and then rushing to the bank? Electronic Funds Transfer (EFT) is available when you file electronic claims via your clearinghouse or directly with the payer.
EFT is similar to direct deposit payroll. Payments are received electronically into your Practice’s bank account eliminating the need to make a trip to the bank. Typically banks credit your account with funds received via EFT immediately. Funds received via checks are often placed on hold for a short period of time. The net results of using EFT to receive insurance payments is quicker access to funds and improved efficiency.
Safety of your funds is assured as noted in the Medicare paper referenced above. Checks are not subject to theft nor can they be lost or left unattended in your office or someone’s briefcase. EFT technology has been proven safe over many years and millions of transactions.
Required by some payers when you choose to receive ERA files, EFT is generally an option provided by payers who recognize the value of efficiency and safety in their operations as well as their clients’ operations. For all the reasons stated and more, payers appear to be moving away from printing and mailing checks. EFT is a proven technology that deserves serious consideration by any business, especially a medical practice.
Implementing ERA and EFT technology will engage the full impact of electronic claims filing currently available to a medical practice. If improving service and increasing profits are the goals, intelligent implementation of technology will play a major role in success.
KW Norris
Technology Consultants, Inc.
2006