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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

Before processing claims, ensure your practice has the tools it needs. In order to help physicians select the proper practice management vendor, the AMA collaborated with the Medical Group Management Association (MGMA) to create the "Selecting a Practice Management System Toolkit". This toolkit provides a roadmap for selecting and purchasing the most appropriate software for your practice.

Electronic Transactions Resources

Reduce the burden of paperwork by getting rid of it. These resources can help your practice make the most of electronic transactions, including electronic funds transfer (EFT) and electronic remittance advice (ERA).

Additionally, the AMA's point-of-care pricing resources can help you go a step further and learn how using electronic transactions can allow your practice to see  increased cash flow by receiving patient payment at the time of service.

Appealing Denials and Disputing Overpayment

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.

Administrative Simplification Advocacy

Through its administrative simplification advocacy, our 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.