Select a practice management system (PMS) that fits your needs
Select a practice management system (PMS) that fits your needs
Verify insurance eligibility electronically before every patient appointment
Reduce prior authorization burdens through electronic transactions
Submit claims electronically to save time and money
Determine the status of your submitted claim
Leverage electronic remittance advice (ERA) to simplify processing of payment information
Review electronic payment options and make an informed choice for your practice
Maximize collection of patient payments
Select a practice management system (PMS) that fits your needs:
As with any technology selection, the “right” PMS for your practice is the one that will best meet the needs of you and your staff. Whether you are purchasing your first PMS or changing to a different product, first turn your attention inward to your practice. Soliciting input from all staff who use and interface with a PMS and including them in the selection process will ensure that you pick a vendor and product that matches your practice’s priorities and needs. A thorough analysis of your practice’s revenue cycle management process and workflow will provide valuable insight into your system’s requirements. Additionally, this type of analysis will help to identify opportunities for automation through the PMS that will improve the efficiency of your practice.
Verify insurance eligibility electronically before every patient appointment:
Unfortunately, the following scenario has probably happened in your practice: you or your staff learn that a patient was not covered by a health plan or has an out-of-network plan after a service has already been provided. You and your patient now both face the unwelcome challenge of addressing a surprise bill that is potentially higher than the patient can pay.
Reduce prior authorization burdens through electronic transactions:
Your practice has no doubt experienced the administrative burdens and delays in care associated with health plans’ prior authorization requirements. The American Medical Association (AMA) believes that prior authorization is currently overused and urges health plans to limit use of these programs to true utilization outliers, instead of broadly applying coverage restrictions to all practices.
Submit claims electronically to save time and money:
Health care claim submission used to require a cumbersome, manual process of completing a paper form, mailing it to a health plan and waiting—sometimes weeks—for a response. Practices that submit claims electronically save time eliminate postage and other mailing expenditures and can more easily track a claim’s status. In addition, electronic claims submission often speeds health plan adjudication and payment.
Determine the status of your submitted claim:
Typically, practices do not know if their claim has been received by the health plan until it is paid, pended or rejected. While some health plans and some clearinghouses offer an acknowledgement transaction to confirm that a claim has been received, this is not currently required by law. To address this issue, many practices utilize an electronic claim status inquiry to confirm receipt of submitted claims, as well as to determine claim status.
Leverage electronic remittance advice (ERA) to simplify processing of payment information:
Reviewing and interpreting paper-based claims remittance information can be a real challenge for physician practices. An ERA is an electronic version of a paper explanation of benefits (EOB). Like a paper EOB, an ERA provides details about the amount billed, the amount being paid by the health plan and the reasons for any differences between the billed and paid amounts. Manual reconciliation processes and sifting through stacks of paper EOBs can be sizable administrative hassles. The standardized ERA offers a way for practices to reduce these burdens, more quickly identify those claims that require reworking and generally have staff spend more time on higher-value activities.
Review electronic payment options and make an informed choice for your practice:
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 fraud. Utilizing electronic payment can simplify your practice’s revenue cycle and lead to faster payment from health plans. However, you should be aware of the benefits and risks of various electronic payment options so you can make the best choice for your practice.
Maximize collection of patient payment:
The growing prevalence of high-deductible health plans means that many patients bear additional financial responsibility for their treatment. In the past, most patients typically had a co-payment due at the time of an appointment; today, many patients owe significantly more for their care due to high deductibles. These trends underscore the importance of your practice’s processes of charging for and collecting patient payments at the time of the appointment.
