The ERA/EFT Mandate HOW IT WILL IMPACT YOUR BUSINESS 2014, all payors will be federally mandated to support electronic funds transfer (EFT) and electronic remittance advice (ERA) in accordance with the requirements specified in the CAQH CORE Operating Rules.1 Billing services and their clients may be wondering how this mandate will affect payor payments and what must be done to be compliant. under the mandate, billing services and their clients have no obligation to accept eRa/eFT from payors. However, taking advantage of the mandate provides an opportunity for billing services to improve efficiencies and reduce administrative costs. Read on to learn how the mandate impacts your business’s profitability. AUTOMATE RECONCILIATION. The mandate requires that payors include the eFT trace number with the remittance to allow easy re-association with the eRa file. Therefore, billing services can reconcile payments and remittances automatically, which reduces hours of manual administrative work and the risk of errors. STOP WAITING FOR MAIL. When your organization accepts eRa/eFT from payors, you will no longer have to wait for paper checks in the mail to get paid. electronic payments arrive much faster than paper checks, allowing you to identify remaining patient responsibility and bill patients sooner. REDUCE YOUR RELIANCE ON THE LOCKBOx. many billing services depend on costly and labor-intensive lockboxes at banks to receive and deposit mailed paper checks. With eRa/eFT, you bypass the lockbox to streamline payment processing and reduce the risk of fraud. STREAMLINE WORKFLOW AND REPORTING. By receiving fully reconciled remittances electronically, billing services and their clients can easily post and report on all remittances to save administrative time and costs. OPPORTUNITIES TO APPLY BEST PRACTICES. The upcoming eRa/eFT mandate helps billing services to reduce their administrative costs. However, the rule specifies that providers – or billing services, on behalf of their clients – need to “apply best practices to transmitting and receiving eRa/eFT transactions” in order to achieve administrative efficiency. Here are a few tips: • ensure staff members and clients can access detailed, customizable reports for all transactions so they can easily view and update all information in real-time. • Leverage a private cloud that has True availability to ensure that all data is safe.2 • manage all transactions through a private cloud that is independently certified and audited against the Payment Card Industry Data security standards (PCI-Dss) and HIPaa.3 • use a CaQH CORe-certified clearinghouse to ensure transactions are compliant with new and upcoming regulations (see www.caqh.org). • Connect to a network to receive eRa/eFT from multiple payors to simplify the registration process. Bill Marvin has been in the revenue cycle industry since 1993 and has pioneered the healthcare payments industry as the president, CEO, and co-founder of InstaMed, the leading Healthcare Payments Network. Prior to InstaMed, Bill was an executive in Accenture’s Health and Life Sciences practice, focused on payer to provider connectivity. Resources 1 For more information on the Operating Rules, visit www.caqh.org/ Host/CORe/eFT-eRa/eFTeRa_CompleteRuleset.pdf 2 For a list of questions to ask vendors about their availability, visit www.instamed.com/blog/true-availability-best-practices-on-the-cloud 3 Check masterCard, Visa, and eHNaC for a list of independently certified solutions/vendors THe JOuRNaL OF THe HeaLTHCaRe BILLINg aND maNagemeNT assOCIaTION 29 By Bill Marvin In
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