Electronic Transmission of Insurance
Electronic transmission of insurance claims is the future of third party billing. STI has years of experience setting up practices to file insurance electronically. Our staff is constantly in touch with the carriers to keep up-to-date on the latest requirements. We can easily prepare your office for this money saving procedure.
"The Health Care Financing Administration (HCFA) has reported that it rejects 26% of the claims it receives. While that number is astonishing, more astonishing is the fact that 40% of those rejected claims are never resubmitted. These rejections and lost claims confirm that there are significant billing problems in many provider organizations. Using Medicare’s statistics, the lost revenue per physician is about 10%. On a per physician basis, this ranges from approximately $25,000 to over $50,000 per year.".
If you have a manual billing system or an inefficient computer system you may be experiencing this kind of insurance rejection rate and not even be aware of it. Electronic billing with Perfect Care for Windows provides practice benefits to avoid these pitfalls and get you processed and paid faster.
Electronically submitted claims are not manually keypunched or reviewed and therefore less likely to be rejected. Studies show that practices that bill electronically experience 21% fewer rejections.
Typically within 24-48 hours you will be electronically notified that the submitted claims have been accepted or rejected. Rejected claims can be quickly corrected and resubmitted the same day.
Electronically submitted claims are typically paid faster. "By law, Medicare must pay an electronic claim in 14 days. The same paper claim wouldn’t be paid until day 26." "Aetna US Healthcare recently guaranteed payment within 15 business days of clean claims that are submitted electronically."
Electronically submitted claims are automatically tracked. If a claim is not paid within the agreed to time, a report can be generated, the carrier contacted and the charge reviewed, and Perfect Care for Windows can automatically resubmit the claim.
After you are paid, Perfect Care checks your contracted fees to ensure that you are being paid correctly, and automatically bills your secondary carrier or the patient. Medicare payments will automatically post.
Best of all, STI has never charged a practice an electronic transmission per claim fee.
HCFA reports that the average physician doesn’t collect between $25,000 and $50,000 per year due to poor billing procedures.
The Paper Chase
With Perfect Care for Windows® you can electronically bill commercial carriers as well as Medicare. If your current practice computer is only electronically billing Medicare claims you may be losing revenue as well. Many practices face an additional labor cost in tracking hard-copy commercial claims. The billing staff in most practices complain about the delay in payment from commercial carriers and the amount of time spent on insurance follow-up and requests from carriers for resubmital of hard-copy claims.
"If you submit claims electronically you have an electronic audit trail that shows when a payer received every claim you sent out." With Perfect Care for Windows® you will receive a confirmation and status typically within 24 to 48 hours. If the claim was rejected it can be corrected immediately and resubmitted the same day. Accepted claims do not require a follow-up call and should be paid quickly.
Electronic Benefits
A recent New Jersey Medicine article explains three major cost advantages of electronic claim submission:
Less cost per claim - There is an automatic "fixed cost" per claim to filing hard-copy claims the average hard-copy claim costs $1-$1.50 to send using this conservative estimate: 500 claims/month x $0.60 = $300/month
Faster turnaround - Hard-copy Medicare claims are held for 27 days from the day they are received; electronic Medicare claims are processed in 14 days. By allowing insurance carriers to hold your money for two to four weeks longer, they earn the interest, not you. On a monthly income of $20,000 the cost of lost interest income could range from $100 to $300 per month.
Immediate feedback on edit/ rejections - There is nothing more frustrating than waiting six weeks for payment of a hard-copy claim only to find that it was rejected. With electronic claims, you can usually receive feedback on the status of claims within 24 hours.
Medicare Pays Electronic Claims 13 Days Faster than Paper Claims
Effective October 1, 1992, physicians who file Medicare claims electronically will be reimbursed as much as 13 days faster than doctors who file paper claims. Under a new law (H.R. 5677) all physicians who file their Medicare claims electronically are to be paid in no less than 14 days after the carrier receives the claim; physicians who submit paper claims will receive reimbursement in no less than 27 days.
The Cost of an Inefficient System
If your practice is not currently electronically billing every possible insurance carrier, your costs can be far greater than the cost to purchase Perfect Care for Windows®.
The above HCFA example claims that many providers are losing between $25,000 and $50,000 per year. This is in addition to the above New Jersey Medicine article showing a fixed-cost of about $300 per month as well as lost interest of between $100 and $300 per month for hard-copy billing . Compare the costs of an inefficient billing system with the monthly lease price of a typical Perfect Care System at $404/month.
Medical Economics states "These days it costs money to be computer phobic. Even an outdated system can be a drag on your revenue." Is your practice experiencing revenue delays? If you are sending hard-copy claims or have an old billing system that can only electronically bill Medicare you may be leaving money on the table. "While you may balk at spending the money, consultants stress that the system soon pays for itself." "If you can't track payments by carrier and account, you'll never know whether you get paid according to contract".
Billing Service
Medical Economics claims that practices using a billing service have additional error concerns, "If you use a billing service as a middleman between your office and the insurance company, there's yet another chance that typos will be introduced or important information omitted."
With Perfect Care direct electronic transmission of insurance claims to Medicare, Blue Shield and Medicaid is included with the basic system. We do not charge you extra to transmit electronically like some vendors. STI is a Preferred VIP Vendor with the Medicare Program offering you all electronic services with the basic system. STI is also a Preferred Electronic Vendor with U.S. Healthcare for both primary care and specialist practices. We provide an electronic interface direct to U.S. Healthcare from your computer system. This module allows you to submit encounter forms electronically, complete and automatically type referral forms, check patient enrollment information, find answers to frequently asked questions, and more.
Commercial Carriers
Perfect Care® files electronic claims to your commercial carriers via an interface to the NEIC Clearing House. Unlike most other practice management systems, with Perfect Care® there is no transmission charge for each commercial claim that you electronically send to NEIC.
Automatic Billing
Billing is the heart of any Practice Management System. With Perfect Care® you can have multiple prices, or CPT codes for each procedure. It automatically bills secondary, tertiary, and the patient after the primary pays. It handles piggyback insurance situations and reminds you to attach Op Notes when required. The system handles insurance, workman's compensation and patient cycle billing. Perfect Care® is an open item system that bills, and tracks every charge on the patient statement, as preferred by most CPA's.
Perfect Care ®also notifies you about other important information like the patient's co-pay amount, when patients are within the universal surgical follow-up period, if a duplicate patient charge exists with the same date, or if a managed care approval number has expired, is about to expire, and the number of visits remaining.
Accounts Receivable
Often with a manual system, a practice is so overwhelmed with billing that there is no time to follow-up with collections. Perfect Care® tracks your open charges individually until they are collected, and compares them against your allowable amount for proper payment.
Management reports show outstanding charges for each insurance carrier so you can call to collect. Aged Receivable reports direct your staff to collect the oldest charges first before they become a collection problem. Perfect Care can even automatically write personal collection letters to your patients. Perfect Care allows budget plans, finance charges, and generous space for collection notes both for internal use, and printable on your patient statements.
Be Informed
Primary care physicians who use computers to tickle their memories are twice as likely as other doctors to administer flu vaccine to high risk patients, a new study suggests. The three-year study involves patients who were over 65 or had chronic lung disease, asthma, diabetes mellitus, congestive heart failure, or severe renal or hepatic failure. Patients whose doctors received computerized reminders had a 10 to 30% lower rate of hospitalization, ER visits, and tests for respiratory ailments during the winter.
* Reprinted from Medical Economics May 10, 1993
Patient Recall with Letter Writer
Perfect Care® allows you to schedule recall reasons and dates in the computer. You can automatically send postcards or recall letters with the recall reason in your own words. Recall will show on the Recalls Not Seen Report for additional follow-up by your staff.
Auto Posting
One of the most disliked jobs in a practice is posting the Medicare Explanation of Medical Benefits (EOMB) This is a very tedious and time consuming job if it is done correctly. Not only do you need to post every procedure charge to the patient ledger card, but you also need to check your allowable profile to ensure you are paid correctly, and pass the balance on to the secondary insurance carrier for billing, or on to the patient bill. Perfect Care ®electronically posts your Medicare and Pennsylvania Blue Shield EOMB's automatically, checks your profiles for accuracy, and balance bills, saving most practices hundreds of labor hours each year. This time can be better spent with patient care, or collecting patient overdue balances.
Other Business Applications
Accounting and Management Reports
Immunization Reporting
Payment Analysis
Aged Receivable - Patient or Insurance
Inventory Control
Practice Analysis
Appointment Scheduling
Laboratory Requisitions
Recall Postcards and Letters
Autoposting of the EOMB
Letter Writing
Referral Analysis
Clinical Research and Inquiry
Location Analysis
Remote/Home Call-Up
Collection Accounting/Bad Debt System
Managed Care Reporting
Superbills/Routing Slips
Day Sheets
Mailing Labels
Surgery Follow-up Days
Electronic Reconciliation
Patient Inquiry with Notes
Walk-Out Patient Bill
System Conversion
Over 70% of the systems we install are to practices that were already computerized with another practice management system. The main reason they gave for leaving their old software vendor was poor support and lack of adequate software updates. Perfect Care® constantly updates and enhances the system to keep you up-to-date. If you currently have another computer system, we can provide you with a price quotation for data conversion of your patient data to the Perfect Care® System. Data conversion saves your staff the time required to re-key patient information into Perfect Care®. We can also provide you with both diagnosis and procedure codes for your practice specialty to help in the conversion process.
Training
STI provides on-site installation assistance and product training in your office location as part of the system cost. To minimize pressure on your people, installation is typically accomplished over a 6-week period with multiple training visits. Faster installations are available.
Ongoing Support
Ongoing support is the most important component of your system and often overlooked by new buyers. Good support for your hardware and people, as well as on-going software updates are required to protect your computer investment. Without good support and updates your system will not be used and your total investment is lost. In a recent IBM study, system support was the number one buying criteria of experienced medical software buyers.
User Group Meetings
The best way to learn about new techniques is to talk with successful colleagues. At STI we have local user group meetings. These meetings permit you and your business manager to learn and share new ideas. Discussions include planned software enhancements, new insurance regulations and business techniques, new program ideas, and ensures everyone continues to get the most from their Perfect Care® System.
ChartMaker® is a speech-enabled, pen-based, and template-driven system of Electronic Medical Records, designed to produce legible, detailed patient charts to help comply with E&M guidelines by helping you to determine the correct E&M code from the completed office note.
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