GeBBS Healthcare RCM Blog

New Year's Resolutions Can Be Achieved If You Have a Plan

Posted on Thu, Jan 14, 2016 @ 07:00 AM

A new year presents a fresh opportunity to set annual goals and create a plan to achieve them.  Many people make New Year’s resolutions where they strive to do better than they have in the past.  Often the most successfully attained resolutions are the ones that are documented and backed-up with a plan to achieve them. 

NewYearsRes-600x400.jpgNew Year’s resolutions are not limited to self-improvement in your personal life, but can also impact your business life.  What are the New Year resolutions for your job?  They can range from simply being more efficient, or to being more resourceful and proactive by planning ahead instead of always working in a crisis mode.

If the foregoing resolutions seem viable to you, what steps can you take to achieve them?  If it is about being more efficient -- are you being more technology savvy?  Are you working smarter and using your time more efficiently? Are you planning to add more internal resources, or do you plan to outsource some of your workload and have best practices available to you immediately? Maybe you are planning to use a combination of all three. 

For healthcare providers, 2016 goals may include becoming fully ICD-10 compliant. This resolution can be achieved immediately by outsourcing this work to a professional firm who can extend their expertise and best practices to your workflow, while simultaneously improving your patient satisfaction with higher quality service.  For example, your practice may be dealing with paper EOBs, but that doesn’t mean you cannot be more efficient by using an outsource service to transfer paper documents to an electronic format that will expedite your charge entries.

It’s not too late to make 2016 the year where your goals are set and actually achieved.

Tags: Business Process Outsourcing (BPO), Explanations Of Benefits (EOBs), Offshore Medical Billing, Offshore Medical Coding, Outsource Coding, Offshore Revenue Cycle Management, Medical Coding Outsourcing

ERAs Are a Win-Win over Paper EOBs

Posted on Thu, Feb 12, 2015 @ 08:52 AM

The introduction several years ago of the ERA (Electronic Remittance Advice) created a quantum leap in the healthcare billing arena by providing an improvement to the traditional, paper-based EOBs. Astonishingly, many providers have not taken advantage of this revolutionary change. It has been estimated that even today only 46 percent of the claims are processed electronically, while the remaining 54% claims are processed in the traditional paper-based method. However, the Affordable Care Act (ACA) mandated that all healthcare plans adopt and support ERA operating rules before January 1, 2014. 

Here are just a few reasons why you should adopt ERAs:

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Significantly Reduce Processing Time: The major benefit of implementing ERAs is that they significantly bring down the medical claims billing processing time. When payment postings are done electronically, cash flow is accelerated. Also, since everything is electronic, the length of time a paper check or EOB spends in the traditional ‘snail mail’ system is avoided.

Reduce Manual Workflows: By adopting ERAs, providers and healthcare billing companies can reduce manual workflows significantly. Also, the number of employees can be reduced who have been assigned to post payments, or these employees can be reassigned to other medical claims billing functions.

Electronic Posting Efficiency: ERAs allow the use of electronic auto posting features, which enable posting of payments on to the system automatically. The error rate of the automated posting method is much less than that of manual postings, and the time spent correcting manual errors is also lessened.

Cost-Effective: Healthcare providers and medical billing companies can save significant dollars by implementing ERAs. The cost involved in recruiting new employees and training current employees is saved. Huge savings in terms of paper costs, printing costs and mailing costs can be realized. Electronic payment posting is not only time efficient, but also cost-effective.

It’s “Green”: The adoption of ERAs has encouraged several healthcare billing companies and providers to “Go Green.” Approximately, 2.5 billion pieces of paper can be saved by using eco-friendly electronic payment processing.

If you want to immediately achieve these benefits, your practice, hospital or billing company can implement a full-service outsourced payment posting solution that will allow you to instantly convert your paper EOBs to ERAs. Your outsourcing partner will use a technology solution that will import 837 claim data and convert your paper EOB's into ANSI 835/ERAs. The data will easily integrate with your document management system. By outsourcing this work, you can immediately treat every remittance as an ERA.

if you would like more information about the blog topic or how GeBBS can help you:

 

Contact GeBBS Now

 

Tags: Data Analytics, Revenue Cycle Management (RCM), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs), Accounts Receivable (A/R), Insurance Billing Solutions

Why Switch to ERAs?

Posted on Tue, Jan 27, 2015 @ 02:38 PM

Why Switch to ERAs?
In addition to inefficient processing and high administrative costs, paper EOBs contribute to a provider’s

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struggle with physical storage and document inaccessibility. Rummaging through paper archives as a means to investigate and manage secondary claims does not promote efficiency.
Even worse, your medical practice or hospital may miss out on the opportunity to harness the power of big data. In the absence of a readily accessible and centralized data warehouse, providers forfeit the opportunity to effectively analyze their payments and denials in hopes of making smarter business decisions.


How ERA Will Benefit Your Practice?
ERAs were created to handle increasing transaction volumes, complex compliance issues and high administrative costs. ERAs alleviate the tedious process of manually entering, checking and posting payments by automating processes and accelerating the revenue cycle.

The American Medical Association (AMA) estimates that the average provider can save almost $9,500 annually by switching to ERAs. Just imagine your office staff not having to collect mail, file paper documents, manually post payments and speak with payers. Transitioning to ERAs means less administrative waste and more effective patient care.

Adopting a system with the capacity to accept ERAs, post denials and run real-time analytics will allow your practice to track, analyze and manage the revenue cycle seamlessly.

If you cannot accept ERAs today, your practice, hospital or provider group can implement a full-service outsourced payment posting solution that will allow you to immediately convert your paper EOBs to ERAs. Your outsourcing partner will use a technology solution that will import 837 claim data and convert your paper EOB's into ANSI 835/ERAs. The data will easily integrate with your lockbox or document management system. By outsourcing this work, you can immediately treat every remittance as an ERA.

if you would like more information about the blog topic or how GeBBS can help you:Contact GeBBS Now

 

Tags: Data Analytics, Revenue Cycle Management (RCM), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs)

Why ERAs Are More Efficient than EOBs

Posted on Wed, Jan 07, 2015 @ 02:08 PM

It is no secret that the healthcare industry is burdened with costly administrative processes. A good example of this are paper explanation of benefits (EOB) forms that have been estimated to cost nearly $18,600 per physician per year in administrative fees.

With the availability of tools like the electronic remittance advice (ERA), medical practices, hospitals, billing companies and other healthcare providers can jump on the paperless bandwagon and reduce these exorbitant administrative costs.

An electronic remittance advice (ERA) -- or what is frequently referred to as the HIPAA 835 file -- is essentially an electronic EOB. ERAs contain information on whether a claim was paid or denied, final status claims and any adjustments the payer made to the billed amount.

The Affordable Care Act (ACA) requires health plans to implement ERAs under Stage 2 of its Administrative Simplification provision. This represents a strong incentive for payers like Medicare, Medicaid, and other large insurers to phase out paper EOBs.

Why Do You Need ERAs?

Manually posting payments and reconciling patient accounts is time consuming and therefore costly. According to one study, the average physician spends approximately five hours per week on administrative and nonclinical tasks. This translates into three weeks per year on billing and insurance-related tasks.

What causes this “hassle?” EOB formats and claim adjudication codes are not standardized across payers, making it challenging to manually post and reconcile payments. Also, manually processing EOBs is highly susceptible to data entry errors. If your staff accidentally inputs $20.00 instead of $200.00, they will have to check the entire batch to locate the error.

It’s easy to switch to ERAs from paper EOBs. 

If your practice, hospital, billing company or provider group implements a full-service outsourced payment posting solution, you can immediately convert your paper EOBs to ERAs. Your outsourcing partner will use a technology solution that will import 837 claim data and convert your paper EOB's into postable ANSI 835/ERAs. The data will easily integrate with your lockbox or document management system. By outsourcing this work, you can immediately treat every remittance as an ERA.

if you would like more information about the blog topic or how GeBBS can help you:Contact GeBBS Now

 

Tags: Revenue Cycle Management (RCM), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs), Affordable Care Act

Revenue Cycle Management (RCM) and Best Practices Adoption

Posted on Wed, Mar 27, 2013 @ 11:52 AM

For physicians, getting paid properly for the services they provide is extremely important. Between constantly changing coding rules and dozens of insurance contracts -- each with its own coverage, billing and payment terms -- many medical practices find it difficult to keep up. As a result, physicians too often are paid less than they actually should be which impacts their cash flow.

There is hope for improvement! By applying established revenue cycle management (RCM) best practices, most medical groups can substantially increase revenue. These best practices ensure the following functions are accomplished, including:

  • Eligibility and benefit verification
  • Medical coding
  • Charge capture
  • Payment posting
  • Accounts Receivable follow-up

The good news is that you don’t have to take on these tasks by yourself. If you engage an experienced RCM outsourcing partner, you can accomplish all of these crucial functions promptly and efficiently, even though you may have a small internal staff. An outsourcing partner will more than pay for itself by significantly increasing your practice’s insurance payments.

They can also assist with preventing inadequate documentation or coding errors (one of the primary reasons physicians fail to get paid appropriately for their services) by providing highly-trained, certified coders. Some medical practices do not to employ certified coders. As a result, these providers may not select the appropriate level of service, or ensure that the documentation supports the code billed. Some providers even deliberately down-code services for fear they will be accused of compliance violations. Failure to correctly apply code modifiers can significantly impact your practice’s profitability.

An experienced outsourcing partner will exclusively employ certified coders to code all claims; they can also conduct outside audits of their coding to assure compliance and accuracy. These coders are also capable of identifying trends in coding and communicating those trends with your internal staff which prevents future rejections. A full-service RCM outsourcing partner also provides other billing and accounts receivable management services which makes your investment more cost effective. Training is an essential component of an effective outsourcing partner/client initiative. An outsourcing partner will deploy Subject Matter Experts to train and educate your billers to ensure   they are current on billing and coding changes, as well as changes in contracts and payer policies. These experts can also train your staff to utilize workflow technologies and software that can further increase productivity, accuracy and visibility of data gained from coding.

On the technology side, your outsourcing partner can help you ensure your IT billing systems are providing the necessary management support reports, including: overall A/R, A/R by payer contract, denial rates, and variances in received versus expected payments, and trends in payments. These reports will help you spot problems early on, understand which claims require the greatest focus, and better manage staff productivity. Without robust reporting tools, a practice lacks the ability to appropriately manage financial viability. Reporting functionality is a wise investment – and an experienced RCM outsourcing partner, who can optimize your revenue cycle and maximize your financial performance, is an even better investment. 

Tags: Business Process Outsourcing (BPO), Revenue Cycle Management (RCM), Explanations Of Benefits (EOBs), GeBBS Healthcare Solutions, Accounts Receivable (A/R)

How To Heal Merger Maladies with Outsourcing | GeBBS

Posted on Sat, Jan 12, 2013 @ 08:55 PM

When you are one of the largest medical billing services companies in the Southwest U.S. and your mission is to help other physician groups solve their staffing and financial challenges, how do you react when you are faced with these very same issues?

You take the advice of the old adage: “physician heal thyself” and call in a professional outsourcing solutions provider who has just the “right medicine.”

A large Texas-based medical billing services company was created in 2004 from the merger of three distinct but complementary founding companies. Two of the companies are experienced and innovative providers of business and practice management services, exclusively dedicated to supporting the needs of primary care and sub-specialty pediatric practices. The third merged company is the largest billing and practice management company in Houston, TX and specializes in hospital-based physician group practices with emphasis on pathology, anesthesiology and radiology.

While these three independent companies had achieved impressive levels of success singularly, the synergy of providing a broader array of services to physicians across the state of Texas was the driving force behind this merger. While this large combined entity with over 700 employees was effectively managing the critical business tasks physicians need to assure maximum returns — giving them more time to focus on patient care, the merger had created some serious challenges.

The newly formed company was struggling with staffing issues. They understood the benefits of outsourcing and knew they needed an outsourced solution to help them with the increased workload, including data entry as well as other critical daily tasks. Also, they were seeking a delivery platform that could help easily manage the workflow and allow present staff to be redeployed to other critical tasks.

Other challenges came from the lack of a document management system (DMS) in place to manage data electronically: data consisted of paper-based claims and EOB’s. Data entry errors were affecting cash flow. The company had to hire extra manpower to manage their old outsourcing partner which drove up the billing services overhead and lowered profitability.
Turnaround time was not acceptable due to delays in coding, incorrect demographic information, slow charge entry, and payment posting.

In order to get the service delivery and profitability back on track, the medical billing company called GeBBS Healthcare Solutions, a New Jersey-based leader in healthcare revenue cycle management (RCM). Through its multiple Global Delivery Centers (GDC) located in India, GeBBS leverages its people, processes, and technology to provide operational and financial solutions for clients.

To address the company’s issues, GeBBS sent a Transition Manager to ensure a seamless implementation for the project and to establish a clear communications channel. The GeBBS' implementation team also conducted regular web-based training accompanied by conference calls to answer staff member’s questions and manage other training requirements. Then, GeBBS leveraged technology by implementing iP2P ((Intelligent Paper to Payment) solution in order to manage the end-to-end workflow for the billing services company.

iP2P is a full-service outsourced payment posting solution for paper Explanations Of Benefits (EOBs). This solution provides for the automated receipt, processing and posting of all paper payments including insurance payments, patient payments, and correspondence. The iP2P Client Portal provided the company with full visibility into real-time production status, exception management and auditing, along with an image repository for easy retrieval and viewing of EOBs. It allowed the company to revitalize their Accounts Receivable (A/R) by providing immediate electronic access to payment data and images. The iP2P solution integrated with the billing company’s legacy IT hardware and software providing workflow and document management, combined with GeBBS’ highly trained and knowledgeable workforce.

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As a result of the “outsourcing medical treatment,” the medical billing services company achieved “financial well-being.” Staffing and outsourcing services have reduced the FTE costs of the company by an impressive 50%. The staffing plan GeBBS designed and implemented ensured a healthy balance between experienced and trained staff (50% of the team was comprised of experienced resources). This was accomplished by the training department organizing a client specific training program. All trainees were carefully evaluated before being deployed on the live project.

In addition, the pass rate for insurance claims has increased to 98%, enhancing revenue flow. A customized document management system, installed at no additional cost, now automates all of the previous paper-based documents for the company, significantly improving their workflow processes. With the scalability provided by GeBBS, the billing services company can now add new physician contracts without adding new FTEs and investing in additional infrastructure. This allows the company to focus on marketing its services to larger physician groups and hospitals and improve their overall corporate profitability.


Outsourcing Benefits at a Glance:

  • Reduced FTE costs by 50%
  • Increased the pass rate to 98+%
  • Created a customized document management system (DMS) at no additional cost
  • Provided scalability - company can now add new contracts without investing in new resources and infrastructure and can also focus on marketing its services to larger physician groups and hospitals


Visit GeBBS Healthcare Solutions

Tags: Revenue Cycle Management (RCM), Explanations Of Benefits (EOBs), GeBBS Healthcare Solutions, Accounts Receivable (A/R), Best Practices

Understanding Electronic Remittance Advices: Benefits & Obstacles

Posted on Sat, Nov 17, 2012 @ 02:33 PM

EOBs Are Going the Way of the Dinosaurs – Extinction!
Make Sure Your Facility Doesn’t Follow Them.


The “paper blizzard” that the healthcare industry has been caught in for many years is finally starting to subside. The inefficiencies of dealing with too much paper in the healthcare payment process are well documented.

One of the major contributors to this blizzard has been paper-based explanations of benefits (EOBs). Slowly but surely the clouds are clearing with the advent of more and more healthcare plans moving to electronic remittance advices (ERAs). The efficiencies and technological advantages of ERAs will surely doom the old EOBs to eventual extinction.

The federal Centers for Medicare & Medicaid Services (CMS) reports that 28 percent of administrative staff time spent on billing and insurance-related tasks in a doctor's office goes to receiving and posting payments, follow-up, and payment reconciliation.

CMS's interim final rule, which became effective August 10, requires that medical practices adopt electronic funds transfer (EFT) and electronic remittance advice (ERA). The compliance date is January 1, 2014.

CMS reports that when health plans and physician practices implement its regulations, the industry should save between $300 million and $3.3 billion over the next decade.

The Electronic Remittance Advices are a refreshing replacement for paper-based EOB documents.

The ERAs contain the same claims payment information as EOBs, but they are designed to allow for the electronic posting of payments to an accounts receivable system without human intervention. ERAs provide details about claims payments as well as notice of a payment due to the provider via electronic data interchange (EDI). To accomplish this process, the healthcare industry devised a standard for electronically transmitting the explanation of what the insurer is paying to the provider: the HIPAA X12N 835. This is the reason ERAs are commonly referred to as 835s.



ERAs have been around for several years and their benefits are indisputable:

  • full electronic processing
  • no mailing or faxing paper remittances
  • faster and easier payments
  • easier tracking of payments
  • improved compliance and better auditability

Question:
Why then has ERAs adoption not been more wide spread?



The answer:
Technology Challenge. 

technology challenge

A key obstacle to the faster adoption of ERAs is that many healthcare providers are not equipped to handle them. Smaller provider sites – those with less than 10 doctors – still make up a substantial percentage of the U.S. claims volume. Though many of these providers have signed up for ERAs, most do not have the knowledge of how to load the 835s into their systems, so they end up either printing an imaged version of the 835 or reverting to the paper remittance. In either case, the provider must manually key the data, which defeats the ERA purpose.

 Smaller hospitals, in particular, seemed to be challenged by ERAs. Either they can't post the ERAs because their systems are too antiquated, or the format of the ERAs is not compatible and won't post cleanly, creating downstream exceptions that are costly in time and labor.

As a healthcare provider, how can you make sure your facility can take advantage of the benefits of ERAs?

A professional medical billing outsourcing provider can ensure that your facility has the technology and staff training to accept ERAs. They can help you meet the technology challenge that is holding back so many healthcare providers and ensure that you don’t go the way of EOBs and the dinosaurs – extinction. 



Tags: Business Process Outsourcing (BPO), Electronic Remittance Advices (ERAs), Explanations Of Benefits (EOBs)