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| This Eyecom2 diagram shows the process and benefits of using practice management software integrated with electronic clearinghouses. |
If you could process your insurance claims more efficiently and get paid in a fraction of the time it takes with paper forms, wouldn’t you? That’s exactly what electronically submitting claims through a clearinghouse will do for you. The surprising thing is that not all eyecare professionals (ECPs) take advantage of this opportunity for efficiency and improved cash flow.
HOW THEY WORK
Practice management software enables you to compile all of your insurance claims into a single unit that is then sent as a batch to the electronic clearinghouse. In turn, the electronic clearinghouse reviews them for accuracy, notifies you of any that are incomplete or incorrect, and then sends them on to the appropriate carriers for payment.
Since the goal of any claim is to “get paid and get paid the first time through,” according to Sally Crowell of software company Crowell Systems, the two most important benefits of electronic clearinghouses are the speed at which claims are processed and their ability to “scrub” claims for accuracy.
“The biggest benefit is the improved cash flow,” said Bill Hatch of OfficeMate Software Solutions. “Cash flow is critical to any business, and these practices are no exception.”
“The main advantage is that the collection cycle is greatly reduced,” agreed Floyd Web of Eyecom2 Optometric Software. “We’ve been in business for 20 years, and electronic claims have been around for 10 or more years. Integrating with electronic clearinghouses used to be an option that you may or may not use, but now it seems like a necessity. Every-body requires it.”
CLAIMS ‘SCRUBBED’ CLEAN
Incorrectly completed claims are detected much faster too, when compared with paper claims. Invalid paper claims can take as long as 30 to 40 days to be returned and then must be filled out correctly and resubmitted, wasting even more time and substantially slowing cash flow. Electronic clearinghouses, however, notify you immediately if claim information is incorrect or incomplete.
“The clearinghouse scrubs the claims upon receipt and provides a report of any errors found within 24 hours, and in some cases, just a few hours,” according to Donna Lehmann of First Insight, which offers maximEyes software.
A patient’s eligibility can also be determined in advance even before a claim is submitted. In addition, another benefit, according to Lehmann, is that you can “send claims to various commercial insurance companies that otherwise do not have an infrastructure to support electronic claims from various practice management software.”
ACCESS TO INFORMATION
Some clearinghouses enable you to keep track of the any claim’s status as it’s processed through the system. Sue Kaleita of software company Specialist Data Solutions Inc. suggests shopping around because “some offer greater accessibility to edit claims after they’ve been sent to the clearinghouse, while some don’t offer the ability to fix a claim if it was sent in error inaccurately.” She mentioned Netwerkes, in particular, that allows users to access claims online even after the clearinghouse has received it.
Since the goal of submitting claims is ultimately to get paid, among the most helpful features of electronic clearinghouses are Electronic Funds Transfer (EFT) and Electronic Remittance Ad-vice (ERA). EFT does exactly what its name implies and deposits payments directly into your account, while ERA informs you of everything that has been paid and posted to your account. This is all done electronically rather than with paper statements.
WEB-BASED CLEARINGHOUSE
Nuesoft Technologies Inc., which offers its NueMD practice management software as a Web-based system, manages a clearinghouse of its own in the form of its Electronic Data Interchange (EDI) department.
The company has established direct relationships with most government carriers and uses the
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| NueMD’s Web-based claims-processing tool communicates with its own internal clearinghouse as well as with Emdeon. |
Emdeon clearinghouse for most commercial claims. While these are the only two options available through this program, Matt Parrack, director of business development for Nuesoft, said, “Through these two options you can touch every payer in the country.”
Whether or not to use an electronic clearinghouse doesn’t necessarily depend upon the size of the practice, according to Parrack, it depends on who the payer is. “Whether it’s a one-doc office filing five to 10 claims per day, or a 20-doc practice doing substantially more, the number one requirement is who do they need to file claims with.”
Since each carrier requires slightly different information, if a practice wants to electronically submit claims directly to each carrier individually, the practice would have to “customize each electronic file to contain the special requirements that each particular carrier might have,” according to Kaleita.
While SDS can customize, test, and develop each of these files, it does cost money and might only be cost effective for large multi-location practices with thousands of claims. In the long run, such practices might save by not having to pay the per claim fee. For small and mid-size practices, however, going through the electronic clearinghouse is most likely more economical.
REDUCED FILING COSTS
Even while there is a fee for filing claims via an electronic clearinghouse, either paid monthly or a per claim fee averaging less than a dollar per claim, it can still be less expensive than filing traditional paper claims. Delaine Muse of software company Compulink Business Systems, Inc. pointed out each paper claim can cost anywhere from $2 to $5 when you factor in the costs of the paper form itself, the envelope, the stamps, and in particular the labor needed to complete and send the form.
Clearly, labor costs can be one of the biggest savings when incorporating this type of system. For example, Crowell described a practice of three ODs in Ohio that was able to use her company’s software to improve efficiencies so much that they were able to see six more patients per day after one doc retired. Imagine the money they saved by not having to hire a new doctor to replace the retired one. Once the entire system was running smoothly, the practice was also able to eliminate two full-time billing positions. That’s a substantial savings in salaries alone.
STILL ON PAPER?
Surprisingly, Guy Patterson of EMR Logic Systems Inc. said that some of the clients using his company’s software do still send in paper forms, but “very, very few of them.”
Another unexpected thing is that many offices are still not using practice management software. While they may be utilizing a general accounting program such as QuickBooks®, as many as 50%, according to John Knaus of Crystal Practice Management, may not be using any type of specifically optical software at all.
Considering the substantial benefits of using practice management software to submit claims through electronic clearinghouses, could it be that the only reason not all ECPs are using these systems is simply that old habits die hard?
John Sailer is Senior Editor of Vision Care Product News.
WHERE TO FIND IT
Compulink Business Systems, Inc.
800-456-4522 • compulink-software.com
Crowell Systems
800-366-4564 • crowellsystems.com
Crystal Practice Management
800-308-7169 • crystalpm.com
EMRlogic Systems Inc.
866-367-2899 • emrlogic.com
Eyecom2 Optometric Software
800-788-3356 • eyecom2.com
First Insight
800-920-1940 • first-insight.com
Nuesoft Technologies Inc.
800-401-7422 • nuesoft.com
OfficeMate Software Solutions
800-269-3666 • officemate.net
Specialist Data Solutions Inc.
248-351-8737 • specialistdata.com
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