HELP PHYSICIAN PRACTICES “HEAL THAT CLAIM”™ BY TAKING ADVANTAGE OF ERAs AND EFTs Published with permission of the American Medical Association (AMA) drowning in paperwork? The AMA’s “Heal the Claims Process”™ campaign can help. This year’s campaign goal is to help reduce the cost of managing the claims revenue cycle by replacing paper explanation of benefits forms (EOBs) and checks with the use of electronic remittance advices (ERAs) and electronic funds transfers (EFTs). The new Health Insurance Portability and Accountability Act (HIPAA)-mandated EFT and ERA operating rules will become effective on January 1, 2014, so there is no better time than today to encourage your practices to incorporate ERAs and EFTs within your claims revenue cycle. Please review and share the following excerpt with your client practices from one of the many resources ama is providing as part of the campaign. developed with review by the healthcare billing and management association, this resource, “Questions to ask a billing service before signing an eft agreement,” will encourage practices to consider accepting eras and efts and to reach out to you prior to incorporating eras and efts within their practice workflows. be prepared to answer these questions and encourage physician practices to visit www.ama-assn.org/go/era and visit www.ama-assn.org/go/eft for eft and era resources that will walk them through the process. visit www.ama-assn.org/go/join-htc to pledge your support of the campaign and commit to claims processing efficiencies. Questions physician practices can ask a billing service before signing an EFT agreement: 1. Will my billing service help me receive EFT payments and ERAs? Physician practices that transition to sending and receiving electronic transactions, such as efts and eras, typically experience increased efficiencies not only for their own practice but also for their billing services. these benefits include: • fewer days in accounts receivable • less time spent on payment posting • decreased labor expenses • elimination of lost eobs and paper checks • fewer headaches associated with manual processes • less time to put the money into your account • reduced risk of lost or stolen checks • Quicker turnaround time for filing to secondary payors 2. how do i initiate the eft process with each of my contracted health insurers? Your contracted billing service should be able to assist you in the eft enrollment process for your contracted health insurers. 3. how do i make sure the health insurer submits the eras for eft payments through my billing service? once your practice decides to send and receive eras and efts, you are required to complete a new set of electronic data interchange (edi) enrollment forms for each governmental payor and private health insurer. Your billing service has a unique “submitter identifier” that must be linked to your provider billing numbers in order to submit claims electronically and receive eras on your behalf. this will indicate to the various health insurers and clearinghouses that the eras should be redirected to the identified billing service. in some cases, you might choose to receive the eras and eft payments directly and then forward the information to your billing service. if you currently receive payments at your practice location and you are not sure you want your billing service to be able to access payments, you do not need to change this process. some physician practices are concerned about billing service “stability” and like receiving both the eras and payments directly and then providing that information to the billing service so they can post payments. some physician practices use a lock box to accept payor check payments. a lock box is typically an address with your bank to which payments are sent, and (continued on page 33) the journal of the healthcare billing and management association 25
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