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.

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