BENEFITS OF ELECTRONIC REMITTANCE FOR HEALTH CARE

Standard Paper RemittanceThe health care industry faces many administrative and compliance challenges just like the used cars Richmond BC market currently; from collecting and posting patient payments, to understanding and adhering to medical records privacy rules. Fortunately, with today’s technology, standardized electronic transmission of data is available. Electronically transferring patient and payment information provides simple solutions to the health care industry’s administrative and privacy rule burdens.

In the past, the health care industry relied on Standard Paper Remittance (SPR) to receive patients’ medical information. Today, health care facilities have the advantage of receiving Electronic Remittance Advice files from the insurance companies. In some cases, the providers’ electronic records management systems have the capability to receive this information via 835 remittance files. One 835 remittance file per day is sent that combines payment from the insurance or health plan and payment from the patient. The 835 remittance files are created in a format common to all insurance companies.

If the average person were to view the electronic 835 remittance file, the information would appear in a format that is nearly impossible to decipher. It would take an expert many hours to sort through the data. For this reason, electronic records management systems receive the 835 remittance files and create individual patient Explanation of Benefits (EOB) documents. The information is presented in a logical, clear manner. Another benefit of this process is that data is extracted from the 835 remittance files and formatted into standard medical reports. Some possible reports include adjusted claims reports, denied claims reports, deductible claims reports, and provider payment summary reports. Records management systems may be configured to index and store the remittance files, patient EOB documents, and medical reports.

The protection of health care information is of constant concern. The introduction of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires that health claims and payment information is received and stored electronically. Electronic transactions ensure the privacy of patient and payment information. Health care facilities cannot afford to pay the high penalties for noncompliance of HIPAA.

The benefits of receiving remittance files electronically are:

  • Less time is spent on administrative tasks.
  • More time is available for productivity.
  • Compliance rules and regulations are met.
  • Accuracy in receiving and filing patient and payment information is increased.
  • The costs associated with paper, labor, and storage decrease.
  • Remittance advice information is sent and reformatted automatically.

Getting an NPI is free – Not Having One Can Be Costly: If you delay applying for your NPI, you risk your cash flow.

-Enumerate: Enumeration is mandatory for both individual providers and organizations and subparts. When applying for your NPI, CMS urges you to include your legacy identifiers, not only for Medicare but for all payors. If reporting a Medicaid number, include the associated State name. This information is critical for payors in the development of crosswalks to aid in the transition to the NPI.

-Update: Make sure to upgrade your software, HIPAA Transactions, CMS1500, UB04, and/or Dental claim form changes.

-Communicate: Notify your payers once you have obtained your NPI number. As outlined in the Federal Regulation (The Health Insurance Portability and Accountability Act of 1996 (HIPAA)) you must also share your NPI with other providers, health plans, clearinghouses, and any entity that may need it for billing purposes — including designation of ordering or referring physician.

-Collaborate: Check the readiness of your payment partners (such as health plans, TPAs, clearinghouses, etc…)? Not all payers are ready to accept the NPI number at this time. Use both your existing (legacy) number and the NPI number when submitting electronic claims.

-Test: Test transactions well before the deadline. Make sure to test HIPAA Transactions, e.g., 837 Claims, 835 Remittance Advice, and, if you submit paper claims, verify that the data is printed in the correct fields. The new HCFA form has new fields for identifier numbers on lines 17b, 32a and 33a.

-Educate: Focus on staff working on insurance verification of eligibility and claim denial or underpayment follow up.

-Implement: Once you obtain your NPI, it might take about 120 days to do the remaining work to use it. This includes working on your internal billing systems, coordinating with billing services, vendors, and clearinghouses, testing with payers.

These benefits are all possible through the use of an electronic records management system with remittance advice processing. In today’s health care environment, electronically receiving and storing information is becoming more of a necessity and less of an amenity.

Would you like to be sure your health care facility is complying with HIPAA regulations? Do you wish for an automated way of receiving and formatting remittance to free up your time? Investigate solutions to these and other document filing and storage problems by investing in an electronic records management system with remittance advice processing capabilities.

THE COMPETITION IN THE HEALTH CARE INDUSTRY

The health care industry in the United States is exceptional because in spite of so much competition, adding up the wins and losses will get you nothing, which is strange because competition commonly increases value via lesser costs & higher quality as is the case in the used cars Langley market. The insurers have centered on lessening & transferring costs, maximizing their bargaining power & limiting services, as if it was a commodity. They have given broad services without differentiation, basing the competition on handiness & reputation in their market of locality.

Competition In The Health Care IndustryCompetition is supposed to provide the highest value for patients resulting in further innovation. This will not make insurers look like gods but will focus on practice areas that will cater to particular maladies & conditions with superior quality, less expensive services. Health plans will do away with their restrictions permitting members to select from the marketplace the insurers that present the most excellent value for their condition. It will also help clients decide by counseling them, and giving information that gauge the value being given by insurance providers.

But, sad to say, competition in the US is not like this but the other way around. Yet competition that is based on value is not a theory and, in fact, is occurring. Some insurers are starting to provide unusual services, even building the facilities & groups to supply them. They are also amassing the data to evaluate their performance and make their services better.

Competition is thought of as an amazingly potent force in compelling improvement in quality & lowering of costs. And this has been true in other countries or even the here but in other industries. The United States generates more competition compared to other health care systems the world over yet the paradox is the costs are steep & increasing without provisions of superior quality.

No one disputes that health care spending in the U.S. has been rising dramatically. According to the Centers for Medicare and Medicaid Services (CMS), health care spending is projected to reach $8,160 per person per year by the end of 2009 compared to the $356 per person per year it was in 1970. This increase occurred roughly 2.4% faster than the increase in GDP over the same period. Though GDP varies from year-to-year and is therefore an imperfect way to assess a rise in health care costs in comparison to other expenditures from one year to the next, we can still conclude from this data that over the last 40 years the percentage of our national income (personal, business, and governmental) we’ve spent on health care has been rising.

Despite what most assume, this may or may not be bad. It all depends on two things: the reasons why spending on health care has been increasing relative to our GDP and how much value we’ve been getting for each dollar we spend.

The competition that has been happening is not the right kind. The insurance providers are treating health care as a commodity. They have concentrated in lowering the costs and developing their competitive edge with the achievements of one happening at the expense of others. The focus is on transferring the costs to competitors, captivating clients, growth in size in order to raise bargaining power, limiting options & services, and lastly resorting to legal action.

The consequence of all these is big health plans without differentiations and insurance system that stresses range & size. Efforts to change have been futile, as they didn’t deal with the root of the problem. Focusing particularly on conditions will follow in having a more dedicated team, building up facilities which permit for enhanced effectiveness of specialized care.