We recently blogged about best practices for electronic eligibility (e-eligibility) as a means to protect a practice’s revenue cycle by minimizing the need for post-care patient collections. Similarly for specialists who rely on insurance reimbursements from public or private payers, a clearinghouse electronic remittance (e-remittance) service is essential to making sure the practice receives full compensation from payers for services rendered.
Healthcare payers have successfully reduced paper communications with providers, along with associated costs, by instituting automated transaction processing and electronic data interchange initiatives. Physicians are on the receiving end of those electronic transfers in the form of electronic remittance advice (ERA) reports and electronic funds transfer (EFT) receipts, often manually entering the data they contain into practice financial systems.
E-remittance services equip practices with receiving-end automation for posting insurance payments based on ERA reports and EFT receipts. This eliminates the need for data entry, reducing both the associated costs and opportunities for manual errors. These services further automate the process of reconciling balances, highlighting claims that require additional follow-up to enable payment.
As a result, practices that employ e-remittance services can realize multiple benefits, including faster payments, time savings in the elimination of manual back-office procedures, and the convenience of a single, secure and simplified point of remittance data in support of claims management.
E-remittance providers can vary substantially in their offerings. As with e-eligibility services, the ideal e-remittance service will have an expansive payer network to optimize coverage, and the service should integrate with the practice management system to coordinate with revenue cycle management, including monitoring for correct payer reimbursements.
Additional characteristics to look for in an e-remittance service:
- Automated pre-submission error checking, analysis of explanation of benefits (EOB) information, and secondary claims submission
- Ready access to all files stored in a standardized format to enable quick searching to support claims reconciliation
- Consolidation of data from all payers into a single point of access
- Ability to search remits at the payer or patient level based on detailed queries
While an e-remittance service provides tremendous relief to back-office personnel through automation, those who were previously responsible for manual remittance management will want to remain involved to assure optimal performance.
Best practices for specialty providers in support of e-remittance include a review of all insurance payments for accuracy, and all EOBs and ERAs to address delays, denials and reductions, on an ongoing basis; and regularly checking to ensure that remittance advice files and reports have been received and posted to practice management. Beyond that, interaction with e-remittance is largely a matter of following up on ERAs that have been highlighted by the service as needing further action.
By automating so much of remittance management compared with manual processes, and introducing a much higher level of accuracy in the elimination of data entry errors, e-remittance succeeds in streamlining a key component of revenue cycle management while complementing other tools and processes practices have in place now or will in the future. It is an indispensable solution for completing on the practice side an automation chain that is already fully enabled on the payer side—and delivering a great deal of efficiencies in the process.
For more information about how Nextech and its partner Trizetto Provider Solutions (formerly Gateway EDI) can assist you with e-eligibility and e-remittance services, please contact us or call us at 1-866-856-0784.
