I have previously posted about the value of electronic transactions between the dental office and their insurance payers.
I spoke in general about the top transactions in this post, and got more specific with the value of the electronic remittance advice with this post.
This week I will get specific with the real-time eligibility transaction. The appropriate use of this transaction can save your office time and money.
Let me start by providing a definition.
Real-time eligibility verifies a patient’s coverage status with their insurance company and returns certain important properties of that coverage.
If your practice management software provides this capability, it can often be done through the push of a single button.
Here’s a screen shot of how we’ve integrated a real-time eligibility button into our appointment screen for a specific patient.
With the movement of every industry to move to an eco-friendly environment and reduce our use of paper, it is surprising the need to produce another paper form to add to the problem that we are working to resolve. Regardless, the need is still present to submit dental claims on paper.
And on these essential paper claims, there is the avenue to provide information that proved difficult for dental practitioners to convey to the payers that provides benefits for patients.
The dental community has been educated and practicing the method of billing medical insurance for applicable procedures.
As the medical and dental industries become more coordinated in the care of patients, so does the reporting of conditions that impact both medical and dental claims and the decisions made by payers to provide benefits.
The connectivity of the oral and systemic health conditions is being addressed by both medical and dental professionals. Now the time has come for the information to be reported to dental benefit payers by use of the ADA 2012 paper claim form.
Regence BlueCross BlueShield, an insurer in Oregon, Washington, Idaho and Utah, recently announced that they are no longer accepting paper claims or issuing paper checks, which have providers all over these four states scrambling to make sure they have the appropriate electronic processes in place to continue working with this major payer.
As a vendor of practice management software, we have been working with our clients and helping them adapt to this announcement.
In doing this we have been surprised at the number of dental practices who are still not using the electronic attachment services of NEA (National Electronic Attachment, Inc.).
Drug seekers. The term we all dread. Each of us will create a picture in our mind of what that term means.
Every time we have a patient requesting pain medication, we have to stop and ask ourselves “is this patient seeking pain medication to be abused or sold?”
Not a comforting thought for dental professionals since our goal is to help people, especially those in pain.
But what if that person is misusing prescriptions, and not simply a drug seeker with the intention to abuse it or sell it on the streets?
When I think about prescription drug misuse, this is the picture I have that resulted from a visit in a client’s office early in the development process of eRx.
Transaction Standards in the Dental OfficeHave you ever wondered how international airline pilots coordinate their flights with air traffic controllers, who all speak different languages, as they fly over numerous countries?
These controllers have a very critical job of maintaining a safe distance between aircraft as they coordinate altitudes, direction and flight schedules.
The key to this process is world-wide agreed upon standards of communication. This allows a German pilot to coordinate his flight from Madrid to Tokyo as he flies over Spain, Italy, Israel, Saudi Arabia, Oman, India, China and Japan.
Likewise, it is agreed upon standards that allow dental offices, running various practice software products to electronically communicate to insurers.
A standards organization called the American National Standards Institute (ANSI) sets standards in this country for everything from the thread specifications on nuts and bolts to electronic exchanges between a dental office and an insurance company.
Insurance fraud. Malpractice. Racketeering. Embezzlement.
These words alone are enough to scare anyone that owns or manages a dental practice. However, they are words that are seldom discussed amongst doctors and staff.
Doctors trust their staff to accurately manage responsibilities in their dental practice.
Staff trusts the doctors to accurately document and provide standard of care for services.
And yet, some of the most feared avenues that a practice can take are the least discussed.
I attended a presentation by Dr. Roy Shelburne at an Opportunity event who openly shared his indictment in 2010 for insurance fraud, racketeering and money laundering for $17,899.57 in overpayments.
The information presented was very powerful, and I came back with an insight that we tend to lose focus of.
“Here’s a dirty little secret about healthcare: Money is a really big deal. Practices need to be reimbursed, the lights need to be kept on, and even doctors need to get paid.”
Benjamin Harris, Healthcare IT News
Some call it a Payment Disbursement Register (PDR), others call it an Explanation of Benefits (EOB), but when it comes to you over the wires it is an Electronic Remittance Advice (ERA) and to quote Tevye in Fiddler on the Roof, “that would be the sweetest thing of all”.
It is the electronic communication from the insurance carrier to the dental practice on how much, for whom and when your claims have been paid. It usually is accompanied by an Electronic Funds Transfer (EFT) placing the payment for the claims directly into your bank account.
Many dental practices still receive their insurance payments through the mail. These consist of a check and numerous pages of paper providing the detailed breakdown of what has been paid and on whose behalf.
The office takes this paper and dutifully records each credit into the appropriate patient’s account. Time consuming? Yes. Fraught with the potential for error? Yes. Time spent growing your practice or caring for your patients? None.
There is a better way and it has been around long enough to have proved its utility and effectiveness.
The ERA presents you with the ability to post those payments and adjustments to patient accounts with the push of a button. Automatically. No more paper cuts.
As we celebrate the holidays and the new year, we often focus our new year resolutions on our personal lives.
We write down the often repeated goals like “I want to lose 10 lbs” or “I want to play tennis twice a week”.
Even if we apply them to our professional lives, our resolutions echo “I want to provide patients with the best dental care”.
Each of us has obtained a certain skill set in creating new year resolutions that are based on measurable and attainable goals.
However, when was the last time you asked yourself about how you feel about your career? When was the last situation you patted yourself on the back and celebrated something that made you feel good and paid attention to why it felt good? When was the last time you thought about a time that you weren’t your best, and how you would like to change your behavior?
I read an article about a yoga practice titled “Out With the Old: Make space for your New Year’s intentions to flourish by letting go of the past” by Sally Kempton.
Now bear with me, I really know nothing about yoga, but the article was intriguing to me. Maybe because although I feel new resolutions have their value, I also lose interest in them by April. Not something I like to admit to. As new projects, goals and family events push me forward, I often forget about what my goals were on Dec. 31st, of the previous year (sounds like a long time ago already).
