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How physician practices are benefiting

Electronic eligibility verification can help your practice determine patient financial responsibility at the time of service, so that your practice can collect payment from patients before they walk out the door:

  • AMA member Gregory Steinmetz, M.D., from Rhode Island, says, “About 3 years ago, our practice upgraded our billing and scheduling system to a more modernized, robust program. At the time, we were struggling to keep down our accounts receivable. With the new system, the physicians were able to electronically enter the [patient] charges at the time of the office visit. Staff can check insurance eligibility electronically, as well as patient balance information, quickly confirming the account status in the majority of cases. This software has helped our practice dramatically reduce the A/R, and our billing provider consistently given us high marks for our billing and collection practices.” 
  • “We have been collecting copays, balances, and deductible deposits at point of service for many years now,” says practice administrator Sue Zumwalt from California. “At first it took the patients a little to get used to us requiring payment at the time, but now it is the norm.”
  • “Having the capability to check patients’ health insurance eligibility online at the time of service is not only a huge time saver, but it also helps us identify any insurance issues prior to the patient’s office visit,” says AMA member Martin Kerzer, D.O., from Rhode Island. “This in turn decreases our accounts receivable. Advances in technology allow providers and staff more time to focus on patients.”

Physicians and practice managers who have made the transition to administrative practice automation have reported a wide range of benefits:

  • Alyn L. Adrain, M.D., an AMA member from Providence, Rhode Island, says implementing electronic transactions in her practice was a relatively smooth process that has “lead to overall efficiency of the practice.” Dr. Adrian says, "With the efforts of our office and billing staff, we increased the number of automated transactions within our practice. This increase allowed us to get paid sooner. As a result, our claims revenue cycle has improved by providing quicker billing turnaround and processing time. The decision to automate administrative processes, such as billing, has certainly proved to be beneficial for my practice as well as for several other Rhode Island physicians who stated the same thing when they went automated."
  • "I can't even imagine what our workflow would be like without the benefit of using electronic remittance," reports Carol Schlageck, the practice manager at a Colorado practice which has been using electronic remittance systems for more than a decade and processes close to 75 percent of its payments electronically. Her practice manages more than $30 million in annual gross accounts receivable with just six full-time staffers, freeing up valuable time for employees to tend to more critical tasks. "Instead of time being consumed by manually posting payments, we're able to devote time to better management of denials, appeals and aging," adds Ms. Schlageck. And time isn't the only resource being saved by using electronic remittance advice (ERA). Drastically paring back on hard copy documentation has significantly reduced paper, postage and storage costs.
  • For more than 10 years, a large physician practice in Colorado has been reaping a world of benefits from processing claims submissions electronically through a clearinghouse. "Our clearinghouse has 'scrubbers' that help confirm that the claim is 'clean' and ready for submission," according to practice manager Carol Schlageck. "They also provide proof of submission and acceptance from the insurance carrier. This is invaluable when proving timely filing. They provide feedback on the type of rejection errors that we have, which we can use to track down the underlying cause in our accounts receivable accounting system, or to design an educational training tool for staff. And they maintain historical data so we can monitor trends and anticipate potential problems."
  • “When you file electronically, you get paid faster,” says Dr. Barbara Hummel, a solo family practitioner in the Milwaukee area. Dr. Hummel, who began using many of the electronic health care transactions a little over year ago, has already begun to reap the benefits of filing electronically. She says that doing referrals and prior authorizations online have saved her staff many hours. The biggest advantage that Dr. Hummel has found is the time saved: “I can tell you that when I had to do paper claims, not only running the claim, but folding, putting in envelopes, stamping and getting them in the mail. Now it takes me a third of the time.” Which, in turn, “Allows you to do other things for the patients.”

Learn about the savings physician practices have experienced by reviewing and appealing inappropriate delays, denials and reductions in claims payments; implementing practice efficiencies; and reporting unfair health insurer practices.

  • "Sometimes one letter is all it takes," said Jan Faibisoff, MD, an AMA member from Illinois. And he should know. He collected at least $10,000 more in claims by appealing denials with the AMA's "Appeal that Claim" letter templates.
  • One practice in Chicago recovered $19,000 over 6 months from appealing a single type of underpaid claim.
  • Within five months of implementing an effective auditing and appeal process, one practice in Chicago was already recovering as much as $100,000 per month.
  • Health insurers consistently underpaid one practice in Chicago $928.50 per claim for a commonly performed procedure. Implementing a claims auditing and appealing strategy could enable this practice to obtain accurate payment on these claims.
  • A small spinal surgery practice in New Jersey routinely reviews and appeals inappropriate claim denials and reductions in payment. "I appeal everything. I don't give up. The money that I get [as a result of appeals] more than pays for my salary," reports the practice's biller. For instance, one health insurer recently reduced payment on a specific claim. After calling the insurer several times and getting no results, the practice sent a complaint letter to the CEO via certified mail. As a result, the practice was paid the additional $17,500 the insurer owed. The practice's biller submits level I and, if necessary, level II appeals to health insurers. If that doesn't work, the biller then complains to the state Department of Banking and Insurance. "It's time consuming, but it pays off. It more than pays for itself."

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