Administrative Simplification Initiatives
Feel like you’re spending more time with paperwork than with patients? AMA resources can help you streamline claims processing so that you can focus on what matters most—caring for your patients. Use these resources to navigate smoothly through every part of the claims revenue cycle—from choosing a practice management system that meets your practice’s needs, to learning how to make the most of electronic transactions (including EFT and ERA), to addressing denials through effective appealing. With new operating rules for EFT and ERA effective as of January 1, 2014, it’s an opportune time to adopt these transactions, and the AMA’s EFT and ERA toolkits can help.
Also join the AMA Administrative Simplification LinkedIn group to ask questions and comment on discussions about making the most of administrative automation.
Selecting a practice management system toolkit - Before processing claims, ensure your practice has the tools it needs. This toolkit provides a roadmap for selecting and purchasing the most appropriate software for your practice.
Electronic transaction toolkits – Reduce paperwork by getting rid of it. These toolkits can help your practice make the most of electronic transactions, including electronic funds transfer (EFT) and electronic remittance advice (ERA)
Point-of-care pricing toolkit – Go a step further and learn how using electronic transactions can allow your practice to see decreased accounts receivable and more cash flow by receiving patient payment at the time of service.
Payer policies – Navigating the websites of health insurers to find information you need can be complex. The AMA has compiled a list of direct links to key information for many major payers. Use this collection of quick links to reduce the time you and your staff spend searching for answers.
Definitions and use of modifier 25 and modifier 59 webinars – Proper coding is crucial to managing a practice’s claims revenue cycle, but it can be confusing. Knowing when and how to use codes and modifiers ensures that your practice accurately records the services it delivers and is paid fairly for those services. These webinars can help.
Claims Workflow Assistant – Using this tool, your practice can look up the reasons health insurers reported for denying claims on the ERAs you receive, so you can then determine the best steps for your practice to reverse the denial.
Template letters – Once you have identified a claim that was inappropriately denied, AMA members can look here for numerous downloadable template appeal letters that can be easily modified to use in your practice.
Overpayment recovery toolkit – Attempting to determine the validity of alleged overpayments can divert significant time from direct patient care, which results in lost practice revenue. Overpayment demands may be made in very general terms and may also be intimidating. Such amounts are frequently the result of “extrapolated” audits. This resource provides steps your practice can take to challenge inappropriate overpayment recovery requests.
Your AMA is leading the charge for physicians against administrative waste by replacing burdensome, manual processes with seamless, automated solutions. We can eliminate hassles and reduce practice costs in the claims revenue cycle to allow physicians more resources to devote to direct patient care. This will lead to more sustainable practices and more satisfied physicians.
White papers and testimonies – The AMA administrative simplification white papers are developed to raise the awareness and priority of the critical, costly manual processes endured by physician practices. The AMA has also provided extensive testimonies to the National Committee on Vial and Health Statistics (NCVHS) to ensure physicians’ interests in fully automating their practices are represented.
National Health Insurer Report Card (NHIRC) and Administrative Burden Index (ABI) – The AMA publishes an annual report card of the claims revenue cycle activities of the major commercial health insurers and Medicare, including metrics on their timeliness, transparency and accuracy. The ABI was developed to aid practices in identifying efficiencies with the cost of doing business with participating payers in the report card.
“Heal the Claims Process” campaign – The campaign’s goal is to reduce the cost of managing the claims revenue cycle from as much as 14 percent of revenue to just 1 percent.