Keys to Managing Healthcare Claims and Payment Information
Depending on your type of business and reporting requirements, efficiently managing high volumes of information from disparate systems can often require manually aggregating the data. With ReMedics specializing in the processing of healthcare insurance payments, and with creating operational efficiencies, our focus is on three specific business drivers, including: Capture; Integration; and Automation.
In addition to Electronic Remittance Advice (ERA), ReMedics’ services also focus on specific document types that include: Claims; EOBs; and Correspondence. These are the primary documents we collect and index to process, validate and reconcile remittance.
The combination of these business drivers, ERA files, and documents allow us to maximize our client’s information and create efficiencies in their billing and AR operations. Below is a brief explanation of each why they are important.
Key Business Drivers
Acquiring diverse information, regardless of origin or format, provide organized access to critical business records that can be used to communicate and validate your information. Being able to efficiently capture and index volumes of 835 ERA files, 837 claim files, BAI deposits, EOBs, and correspondence is essential to automated workflow. Done correctly, it can also save hours of time in working a single exception to look for missing or questionable information.
Unifying disparate systems and applications increases information flow, sharpens decision making, assists with automating data validation, and improves customer service. Systems Integration ensures the smooth flow of funds from the payor back to each Practice Group’s Clearinghouse and their individual Practice Management Systems. For aggregated environments, with complex multi-vendor environments, having the right tools to connect different application is an important part of automating payment and posting processes.
Implementing automation technology is essential to creating streamlined operational efficiencies and permanent revenue cycle improvements. With the use of Artificial Intelligence (AI) and Robotics Process Automation (RPA), the need for human intervention is minimized and/or removed. By mapping interactions between traditional data entry tasks and Line of Business (LOB) information systems, manual processes in the revenue cycle can be significantly reduced.
Key Document Types
A medical claim is a bill that healthcare providers submit to a patient’s insurance provider. The claim includes relevant medical codes and charges for the care provided. Insurance providers, or payors, then determine how they much of the total claim will be reimbursed to the provider, depending on the member’s individual plan and any pre-determined contract rates with the provider for specific services.
The claim header contains most of the essential information needed for remittance processing. This includes patient and insurance information, the National Provider Identifiers (NPI), diagnosis codes, and overall charge.
Explanation of Benefits (EOBs)
EOBs are sent to healthcare providers, which include doctors, hospitals, clinics, dentists, as well as labs. Each of the services and associated payments listed on and EOB must be reconciled individually with the healthcare provider’s original charge. Additionally, a single EOB sent by an insurance company to a healthcare firm can include multiple patient accounts that can consist of hundreds of pages.
Correspondence contained in medical payment lockboxes provide valuable information in processing payment information and in working appeals. Correspondence can include scanned letters mailed from the payor to the providers, such as: denial explanations; documentation requests; authorization approvals; authorization rejections; medical necessity determinations; and legal communications. These documents are auto-indexed by ReMedics and fully searchable using a variety of extracted data. Link to access these correspondence documents are included in our automated exception worklists.
ReMedics leverages decades of healthcare business office experience, workflow design, and enterprise content management (ECM) to help customers lower costs, increase cash flow and achieve significant ROI. By embracing technologies that complement our services, we advance our ability to deliver true revenue cycle improvements. Talk to us about how we can help to efficiently manage your remittance processing, data validation, and bank reconciliation. Contact us online — or call 440-671-7700.