Contains features that help preclude over/under utilization.
Verify insurance eligibility before every patient appointment.
Should be done electronically by batch using your scheduler.
Collect all copays and remaining deductible at the time of service.
Check with your carriers about any restrictions on collecting co-insurances prior to adjudication.
Submit claims electronically to save time and money.
This is a “no brainer!
Scrubbing tools should be used.
Determine the status of your submitted claim.
Health plans are required to support real-time claim status processing.
Similar to electronic eligibility inquiries, practices can also send “batch” transmissions to health plans to check the status of multiple claims at the same time.
By law, the practice must receive a response by the next business morning.
Leverage electronic remittance advice (ERA).
An ERA is an electronic version of a paper explanation of benefits (EOB). Like a paper EOB, an ERA details the amount billed, the amount being paid by the health plan and the reasons for any differences between the billed and paid amounts.
The ERA uses standardized codes to express everything from the status of a claim to messages about reductions or increases in payment.
Learn from your findings and reengineer your processes.
Review electronic payment options.
Paper checks require your practice to spend time opening envelopes, manually posting payments, endorsing checks and traveling to the bank.
There is also a risk of lost checks and higher potential for embezzlement.
Utilizing electronic payment can simplify your practice’s revenue cycle and lead to faster payment from health plans.
All health plans are required to offer basic ACH EFT at no additional cost beyond a nominal, per-transaction banking fee.