Free Payer Technology

Payers have been investing heavily in technology to help manage data and keep their costs to a minimum. Increasingly, standard information such as network newsletters are being delivered via e-mail or posted only on payer Web sites. Many practices complain that they don’t have the time to look at the Web sites of all of these companies to check for changes and updates, but there is an upside to all this IT investment - online processes that help keep your costs down, too.

Phone verification. How much time is your staff spending on the phone? Many of the tasks commonly done by phone can now be done online instead. Basic front-desk tasks such as eligibility and benefits verification, notifications, and referrals can be performed online at most payers’ Web sites. Many large payers - UnitedHealthcare, Aetna, Cigna, and Wellpoint, to name a few - now have detailed, real-time benefit information available, helping your office to collect what’s due at the time of the visit. Even better, sign up and access is free!

Virtual billing. Your billing department can also save time and effort by utilizing free technology. The following back-office tasks can be performed directly online:

• Claim resubmissions;
  
• Claim status inquiries;
  
• Remittance advice look up; and
  
• Some payers are even offering real-time claims adjudication.

Payer policies. In addition, there is a wealth of other information that can be accessed via the Web that can help streamline practice operations. For instance, every payer has its own rules and processes; it is frustrating and time consuming for your staff to figure out how to work with each one of them. Try a different approach. Rather than leaving a message for a rep who will never call back, first look online. You’d be surprised at the answers you’ll find there:

• Remittance advice code descriptions;
  
• Medical policies containing coding information and descriptions of the criteria required for performing those services;
  
• Searchable formularies that make it quick and easy to compare drug costs;
  
• Provider manuals detailing contact information for denial grievances; and
  
• Job aides that can help you understand the process for getting a resolution to your problem.

There are even educational brochures, cheat sheets, and demos on some sites that can help train your entire staff on individual payer processes.

Here’s an example of how using a payer’s Web site might work.

Let’s say you receive an EOB from one of your payers, denying your Pulse Ox (94760) claim as “not allowed.” You check the claim and see that you coded it in conjunction with an office visit using modifier -59. Previous claims submitted the same way have been paid for in the past. So what’s the problem?

You wisely decide to go to the payer’s Web site to see if you can find your answer there. Plugging CPT code 94760 into the Web site’s “search box” lets you know that this payer has instituted two policy changes that prohibit separate payment for that particular code.

This would explain why you got paid for a 94760 yesterday, but not today. Knowing this prevents you from wasting time and money fighting the denial, and chasing a claim that will never be paid.

So stay current. Sign up for payer e-newsletters online and for payer e-news (those updates outside of the monthly or quarterly newsletters). Check fee schedules quarterly. Do what you can to take advantage of the information and payer processes that now reside online. You’ll save time and money, and it won’t cost you a penny.

Susanne Madden is founder and CEO of The Verden Group, a consulting firm that helps physicians handle the complexity and volume of change in managed care today. She writes and speaks frequently on all aspects of managed care. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.