Electronic claims filing ‘is the way to go’
Electronic claims filing is the way to go’
More are using it, but progress slow
The Davenport, IA-based ophthalmology practice of R.C. Bedell, MD, handles certain patients with an absolute minimum of hassle. When these patients go in for an exam and give the receptionist their insurance card, the receptionist then enters the patient’s ID number into an electronic data interchange (EDI) system. In seconds, the receptionist knows if the patient is eligible for insurance and the amount of copayment required.
By the time the appointment is finished, the insurer has paid the bill, leaving Dr. Bedell’s staff with one less claim to worry about.
"It costs a health care provider up to four dollars to process a claim by paper," says Ron Glassner, executive vice president of VHx, the Cedar Rapids, IA-based electronic claims processing system that administers Bedell’s system. "With EDI technology, it costs less than a dollar. It is truly an amazing cost savings. It’s even more amazing that providers and payers aren’t yet demanding EDI in their offices."
Despite the appeal of EDI, practices have been slow in adopting it, relying instead on labor-intensive paper claims. In fact, some small doctors’ offices still do not have the computer capacity to make converting from paper possible.
"Going to a technology-driven system is an adjustment," says Glassner, "but that short-term adjustment pays off very quickly in productivity and financial savings. Some doctors write off 50% of uncollected copayments as bad debts. That number will drop dramatically when they can determine if a patient is indeed covered by insurance, what procedures are covered, and the co-pay amount. Claims can now be adjudicated on-line and payments can be collected on the spot."
One reason for the slow embrace of EDI is the fact that many payers are still not technologically equipped to handle it. This creates a Catch-22: Payers are not interested in upgrading until more providers have EDI capability, but providers are reluctant to make the switch until payers can accept electronic claims.
A good example of a comprehensive, well-functioning EDI relationship can be found between the Eye Associates Network (EAN) managed care plan in Davenport, IA, and third-party administrator Comprehensive Healthcare Administration. EAN requires all its network providers to install EDI equipment, even if they see only as few as 10 EAN members per month.
"To be able to determine a patient’s benefit without making a phone call is tremendous," says Annette Tomlinson, systems director for Eye Surgeons Associates P.C. in Davenport. "The benefit of not having your staff making phone calls to check on eligibility is probably one of the system’s biggest strengths."
Patients who come to Eye Surgeons Associates give the receptionist a card to swipe through a card reader. Alternatively, the receptionist types in the patient’s social security number to access the patient’s insurance eligibility data. The cost of a transaction between the provider and payer can be as low as 48 cents.
"You figure 33 cents for postage if you mail a claim, and certainly EDI is faster, so there’s definitely an advantage," says Tomlinson. "Electronics is the way to go."
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