When managing your medical practice, it is beneficial to review the business and technical aspects in order to increase productivity and efficiency. The American Medical Association (AMA) states that it is important for physicians to have a Practice Management System (PMS) in place that is compatible with your practice. They also set forth a guideline of six suggestions to streamline your revenue management process.
1. Verify insurance eligibility electronically before visits
When a patient schedules an appointment, scheduling or registration staff can enter the patient’s insurance information electronically into the PMS. One upside to Federal regulations is that insurance companies are required to respond within twenty seconds to clarify the eligibility of insurance for the visit. Knowing this information is both beneficial for the practice and the patient. By being more transparent about upfront costs, this alleviates responsibility from the practice, as the patient has knowledge about the necessary payments for their doctor’s appointment prior to treatment.
In addition to verifying insurance eligibility for patient visits, RXNT|eRx has real-time formulary check for electronic prescriptions. This similar process allows both physicians and patients to learn the costs of medications and to compare the affordability of different medications before writing the prescription.
2. Reduce prior authorization burdens through electronic transactions
The AMA states, “newly available electronic pharmacy prior authorization transactions enable physicians to complete prior authorization requirements as part of the e-Prescribing workflow.”
Electronic prescribing platforms, such as RXNT|eRx, integrate newly available electronic prior authorization technology into the prescription writing workflow. Practices no longer have to struggle with duplicate data entry for prior authorization requirements and can even reduce time spent on the phone with pharmacies and payers alike.
3. Submit claims electronically to save time and money
After generating an electronic claim in RXNT|PM solution, physicians can choose whether to submit the claim electronically following the visit or batch claims. By submitting claims directly to an insurance company or indirectly through a billing service or clearinghouse, PM systems may pre-audit claims to review for incorrect or missing information before it’s release. In order to avoid revenue leakage and/or delayed payment, these built-in checks allow potential errors in claims to be assessed beforehand.
4. Determine the status of a submitted claim
Another way to free up time in your practice is reviewing the status of a submitted claim. The AMA states that “health plans are required to support real-time claim status processing.” Too often practices are unaware of a status of a claim until it is either paid, pending, or rejected by the health plan. RXNT|PM system has the ability to produce common reports such as an aging report, so physicians are able to see a snapshot of all of their claims within seconds.
5. Use Electronic Remittance Advice (ERA) to simplify processing of payment information
An ERA is an electronic version of a medical insurance payment explanation of benefits. A standardized ERA can quickly identify claims that need reworking. When solutions such as RXNT|PM are equipped with ERA, inconsistency of health plans’ proprietary payments adjustment codes and paper remittance statements around the office are a thing of the past.
6. Maximize collection of patient payment
The first step of maximizing payment begins with the correct codes, such as CPT or ICD codes. Then electronic systems can complete eligibility checks and verify that coding is to the degree of necessary specificity. Additionally, the growing prevalence of high-deductible health plans shifts more of the financial responsibility to the patient for their treatments. Collecting payments during the appointment will not only increase cash flow but also decrease the accounts receivable and back-end collection costs.
Ultimately, there are multiple processes that can be implemented into a medical practice to increase efficiency and productivity. RXNT offers fully integrated EHR, PM and E-Prescribing solutions that enable physicians to streamline their workflow. To learn more about the benefits of RXNT’s solutions for your practice, contact us at 800-943-7968 option 3 or email us at [email protected].