The Blueprint for a Successful Patient Payment Strategy
ERA Posting Improves Practice Efficiecy draft 022714
1. ERA Posting Improves Practice
Efficiency
Jerrie K. Weith, FHFMA, CMPE
Chastity D. Werner, RHIT, CMPE, NCP
Anders Health Care Services Webinar Series
March 19th, 2014
2. Learning Objectives
Background and benefits
Creating a plan
Set-up
The process
Reconciliation that works
Automation opportunities
Resources
3. Background & Benefits
Source: The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, ed. 2, Walker-Keegan, Woodcock, Larch.
More efficient, saves time, saves money
Old process: opening mail, logging in payments,
stamping checks for deposit, preparing the deposit
and courier
EFT: payer directly transmits the funds it owes a
medical practice to the medical practice’s bank
account. ERA is forwarded to practice with
payment details.
4. Background & Benefits
CAQH CORE 360: Uniform Use of CARCs and RARCs (835) Rule -
Problem Addressed & Key Impact
Problem addressed by the rule:
Providers do not receive uniform code combinations for same or
similar business scenarios from all health plans; as a result, are
unable to automatically post claim payment adjustments and denials
accurately and consistently
Focus on minimum business scenarios with maximum set of code
combinations targeting 80% of major provider usage problems/high
volume code combinations
Without business scenarios and maximum set of code combinations,
there are over 800 RARCs, approximately 200 CARCs and 4 CAGCs
resulting in thousands of possible code combinations for review by
providers
Reference: www.caqh.org
5. Key impact:
Begins to address a significant industry challenge by addressing
high-volume issues
Providers can more effectively use ERA data when definitions for
claim payment adjustments or denials are consistent across all
health plans, resulting in better revenue cycle and cash flow
management
Providers can more effectively obtain payment from patients, more
quickly generate cross-over claims to other payers, and reduce
open accounts receivable
Requires more focus on the use of standard codes (not proprietary
codes)
Background & Benefits
Reference: www.caqh.org
6. Background & Benefits
46% 51%
• Transaction count of payer payments
disbursed via EFT
• 5% increase over 2 year period
• PPACA mandate effective date 1/1/2014
Reference: InstaMed Trends in Healthcare Payments Annual Report: 2012
$300 billion is spent annually
on manual and paper
intensive processes to
disburse payments from
payers to providers.
7. Background & Benefits
Increased efficiency!
Faster payments!
Increased time with patients!
Interface with clearinghouse
Direct via payer website or
clearinghouse
Reference: http://www.aetna.com/provider/medical/service_med/electronic_med/edi_calculator/EDI_Savings_Calc.html
9. Background & Benefits
FTEs 3
Hours designated to posting payments 1,456
Rate $16.25
Total $70,980
3 FTEs devote 70% of
their time to posting
payments/30% to
following up on accounts
• 2,080 x .70=1456
hours
Average wages $13 hour
+ benefits = $16.25
FTEs 1
Hours designated to posting payments 1,456
Rate $16.25
Total $23,660
Manual Posting
Electronic Posting
14. Set-Up
Perform payer
analysis
Enroll with payers
(direct or via
clearinghouse)
System set-up
payer profiles
Payer Profiles
Set-up according to
payer
ERA payer ID
Remittance library
Reason code set-up
Automation according
to reason code
Create a path
between practice &
clearinghouse/payer
15. Set-Up
Clearinghouse
• ERA/EFT set-up
• Internal set-up
Set paths for communication
• Perform payer/ERA analysis
Payers
• Direct ERA enrollment
More complex
EFT enrollment
http://www.ama-assn.org/ama/pub/physician-resources/practice-management-
center/health-insurer-payer-relations/payer-specific-information.page?
22. Process
System
• Process
Import remittance
Create a batch name
– Payer name_deposit date_amount
Process date versus post date
Reason codes again
24. Reconciliation That Works
Payment posting
• Contractual
• Non-contractual
• Post all zero pays
• Reconciliation
Reconciliation Process:
1) Separate deposits
2) One batch per deposit
3) Uniform batch description
(i.e. Anthem 03/19/2014 $34,584.03 )
4) Match to bank deposits to system
(i.e. download bank report & system
report to Excel then sort data
accordingly)
26. Automation Opportunities
Real time edits
• Task PMS claim edits
• GIGO or
• Clean claims out=$$$
Electronic transactions
• 837-electronic claims
• 835-remittance advice
• 270/271-elibility
benefit inquiry and
response
• 276/277-claim status
inquiry and response
27. Automation Opportunities
100 claims per day X 20 days a month 2,000 claims
20% denial rate
2,000 claims X 20% = 400 claims
33% of denials are never recovered
400 X 33% = 132
132 X $100.00 (average reimbursement) = $13,200
monthly
Source: The Physician Billing Process: 12 Potholes to Avoid in the Road to Getting Paid, ed. 2,
Walker-Keegan, Woodcock, Larch.
29. Anders Webinar Series
• Credentialing Doesn’t Have to be Hard!
• June 18
• Effective Technology Will Elevate Your Practice
• September 17
• 2015 – Here We Come!
• November 19
http://anderscpa.com/webinar-series/
31. Anders Health Care Services
Anders Health Care Services optimizes staff,
resources and revenue for hospitals and
physicians by offering solutions and direction to
complex practice management issues.
We provide an integrated approach from the
financial, operational, compliance and strategic
perspectives.
32. Anders Health Care Services
Jerrie K. Weith, FHFMA, CMPE
314-655-5558
jweith@anderscpa.com
Chastity D. Werner, RHIT, CMPE, NCP
314-655-5561
cwerner@anderscpa.com
33. Anders Health Care Services
Brian McCook bmccook@anderscpa.com
John McGuire jmcguire@anderscpa.com
Brian Meyers bmeyers@anderscpa.com
Jerrie Weith jweith@anderscpa.com
Chastity Werner cwerner@anderscpa.com
314-655-5500
www.andershealthcare.com
Editor's Notes
JW slide
Scheduling
Batch eligibility
CAC
Charge entry in 24 hours
Bill Lag time 48 hours
Claim status real time
