Take Advantage of Payer Technologies

Verifying patient eligibility, dealing with claims issues, filling out paperwork involved in precertification and prior authorization, processing hundreds of payer remittances and patient bills - these tasks all consume massive amounts of staff time and result in escalating costs for your practice. How much? It has been reported that billing and insurance-related functions consume as much as 14 percent of medical group revenue, or $85,276 per full-time equivalent physician.

Meanwhile, payers have been slashing their costs by investing heavily in technology to help manage data and processes. Newsletters are being delivered via e-mail or posted only on payer Web sites, and remittances are being sent electronically in order to keep mailing costs down. Many processes that were previously paper and fax based are now available online. But is your practice taking advantage of all of this technology? You may be surprised to learn that payers' IT investments may help keep your costs down too.

Here are some Web technologies that are currently available to practices:

Eligibility verification. How much time is your staff spending on the phone performing a simple, yet critical, task like benefit eligibility? Almost every commercial payer has a Web site where staff can log in and check eligibility - and many large payers have detailed, real-time benefit information available, helping your office to collect what's due at the time of the visit.

Claims management. Most practices submit claims electronically these days. But what happens when there are denials or claims processing errors? Unnecessary time spent on the phone trying to get them resolved. Instead, look online. Once you have a log in and password to a payer's portal (or a single sign-on to a multi-payer portal like Navinet) staff can look up individual claims, access fee schedules, resubmit missing claims, submit claims projects in the case of multiple errors, perform appeals, and generally manage claims much more effectively and efficiently than they can over the phone.

Payment management. Still receiving paper checks? It takes substantial time to post payments, write deposit slips, and send staff to the bank every day - not mention the potential risks for fraud and theft. Most commercial payers now offer Electronic Fund Transfer (or EFT) whereby payments are deposited directly into your bank account. You get access to those payments faster, and may even save on bank fees too.

Referrals, notifications, preauthorizations. Does your clinical staff have a list of payers' precertification phone numbers as long as your arm? Do them a favor and get them online instead. Most referrals and procedures require only four or five pieces of data that can be completed in a couple of minutes. Compare that to time spent holding on the phone and filling out and faxing paper forms. The time your staff can save will add up quickly!

In addition to these currently available functions, payers are rapidly advancing to more sophisticated offerings such as WEDI (Workgroup for Electronic Data Interchange) technology-enabled member cards. With the use of an inexpensive card reader that plugs into any Internet-enabled computer via a USB port, practices will be able to pull up patients' insurance details. It works much like a credit card does, storing information on the magnetic stripe on the back of the card. Through secure, standardized healthcare transactions, practices will be able to pull up patient eligibility, unmet deductibles, copay amounts, and claims status, as well as perform real-time claims adjudications.

So take advantage of all the payer technologies you can, and keep your costs of doing business down.

Susanne Madden, MBA, is founder and CEO of The Verden Group, a consulting and business intelligence firm that specializes in practice management, physician education, and healthcare policy. She can be reached at madden@theverdengroup.com or by visiting www.theverdengroup.com.