Magical Processes that Improve Efficiency & Decrease Overhead
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1 Magical Processes that Improve Efficiency & Decrease Overhead Roland H. Winter, M.D. Alpine Orthopaedic Medical Group, Inc. Stockton, California COA 2011
2 THE PAPER TRAIL MESS
3 THE ELECTRONIC TRAIL
4 EDI / 837 TRANSMISSIONS ELECTRONIC DATA INTERCHANGE Claim Filing via Insurance Carriers/Clearing Houses - Submit claims to insurance carriers - Notification of claim rejection - Ability to make corrections - Resubmission of clean claim to carrier
5 BENEFITS OF EDI SAVINGS: Reduction in Staff (No more folding & stuffing envelopes) Error notification 2 minutes vs 30 days Verification that claims received & accepted Online Work Comp claim number, date-ofinjury verification & Electronic PR2, PR4s, etc. Decreased postage, Ink, Paper, wear & tear of equipment.
6 ERA / 835 TRANSMISSIONS ELECTRONIC REMITTANCE ADVICE AKA: Explanation of benefits (EOB) - via Clearinghouse/Insurance Carrier BENEFITS - ELIMINATES: - Snail mail deliveries, opening of mail, handling & storing of paper.
7 EFT ELECTRONIC FUND TRANSFER into checking/savings accounts BENEFITS ELIMINATES -Delays with snail mail, opening mail, stamping checks & deposit slips -Transport of deposits to banks -Increase receipt of $, 7-14 days vs days
8 eposting ELECTRONIC POSTING OF RECEIPTS to individual patient accounts BENEFITS - ELIMINATE: Manual data entry errors Wrong account errors Posting process takes less than one minutes vs. up to 2-3 hours for multiple patient payment EOBs.
9 WHO DO WE BILL VIA EDI? Aetna Blue Cross Blue Shield Delta Health Systems Health Net Hill Physicians MediCal Medicare ( & Railroad Medicare) Noridian Operating Engineers Pension Health & Welfare Secure Horizons Sutter Health U.S. Department of Labor United Healthcare And others
10 EDI Worker s Comp Carriers: ADP AIG Benchmark Insurance C.N.A Department of Energy Department of Labor ESIS First Comp Gallagher Bassett Services P.G.&E. Preferred Medical Sedgwick State Compensation Insurance Fund Zenith and others
11 WHO PROVIDES US WITH ERAs? Aetna Blue Cross Blue Shield Delta Health Systems Health Net Hill Physicians MediCal Medicare Noridian Operating Engineers Pension Health & Welfare Secure Horizons Sutter Select U. S. Department of Labor United Health Care
12 ERAs for Worker s Comp Carriers: C.N.A ESIS First Comp Gallagher Bassett Services Sedgwick Zenith
13 WHO PROVIDES US WITH EFTs? Aetna Blue Cross Blue Shield Delta Health Systems Health Net Hill Physicians MediCal Operating Engineers Medicare (& Railroad Medicare) Noridian Pension Health & Welfare Sutter Select U.S. Department of Labor United Healthcare Worker s Comp Carriers: Sedgwick
14 WHICH CARRIERS DO WE epost Receipts? Aetna Blue Cross Blue Shield Health Net Hill Physicians MediCal Medicare Noridian Secure Horizons United Healthcare. Worker s Comp Carriers:NONE!!!
15 $ SAVINGS BILLING STAFF - April 1998, 8 physicians / 7 FTE Ratio:.88 FTE / physician - April 2011, 11 physicians / 7 FTE Ratio:.64 FTE / physician 27% decrease in staffing needs / 2.68 FTE Yearly wage / benefits = approx $111,500.00
16 $ SAVINGS 1 st CLASS POSTAGE RATES HAVE INCREASED BY 51% FROM 29 cents to 44 cents POSTAGE EXPENSE = $19, vs 2010 = $20, % increase / $ % increase + 57% increase in Drs = or $28, Postage cost usage proportioned to the # of doctors in 2010 would cost $ 48, in 2010 or 147% increase.
17 COST OF IMPLEMENTATION EDI -Software $5K - Clearinghouse/Carrier usage Non-Work Comp Claims $0 -Clearinghouse usage Worker s Comp Claims $0 to $1.00 per claim -Staff Training $1K
18 ERA -Clearinghouse/Insurance Carrier/Worker s Comp Claims = $0 -Staff Training = $1K
19 EFT - Banking Fee = $0 - Staff setup cost = $1K - Bank to PM System balancing = $ per month.
20 eposting of Receipts: -Practice Management Software = $2, $5, Staff Training = $1K
21
22 Cost EDI Setup & Training $6K ERA - Setup & Training $1K EFT - Setup & Training $1K epost Setup & Training $6K FIRST YEAR COST $14,000.00
23 Savings Postage Savings $ 48, Staff Savings $111, Less Miscellaneous Savings of Costs of wear & tear to copiers, ink, paper supplies of $8, per year TOTAL YEARLY SAVINGS $168,000.00
24 Q & A See Anne McCune, Lunch anneaomg@aol.com Call
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