Payment Revolution in Healthcare Find Out the Magic Behind EFT ERA Enrollment 

If you’ve spent enough time managing healthcare payments, you know it’s not all sunshine and rainbows. Paper checks get lost, reimbursement delays are a common headache, and the manual labor involved can drive anyone up the wall. But what if there was a way to sprinkle a little magic over these issues? Enter EFT (Electronic Funds Transfer) and ERA (Electronic Remittance Advice) enrollment—a modern-day solution for seamless payments to healthcare providers. 

In this guide, we’ll unravel the mysteries of EFT/ERA enrollment, highlighting its importance, benefits, and how you can get onboard this payment revolution. Whether you’re a healthcare provider, medical billing professional, or healthcare administrator, this post is designed to offer valuable insights and practical tips to streamline your billing processes. 

Understanding the Dynamics EFT and ERA Explained 

Imagine a world where payments flow directly into your account without fuss, and detailed transactional information is just a click away. That’s the world of EFT and ERA. 

EFT is your trusted courier, ensuring that funds move seamlessly from payer to provider. No stamps required. Meanwhile, ERA is like the Rosetta Stone for your payments. It decodes complex payment information into a format you can easily digest. 

These two tools are reshaping the payment landscape in healthcare, offering a streamlined approach that’s faster, more efficient, and remarkably secure. 

The Perks Why EFT ERA Enrollment is a Game Changer 

Why should you consider enrolling in EFT/ERA? Hold onto your hats because the benefits are substantial: 

• Speed and Efficiency: Faster transactions mean quicker access to funds. No more waiting for checks! 

• Accuracy in Accounting: With ERAs, you get detailed payment information, reducing errors in financial documentation. 

• Cost Savings: Less paper, less hassle. Enjoy reduced administrative costs as you wave goodbye to traditional check handling. 

• Enhanced Security: EFTs and ERAs are fortified with security measures to protect sensitive financial information. 

Enrolling in EFT/ERA isn’t just a good idea; it’s a smart business move that can save both time and resources. 

Enrolling in EFT ERA A Step-by-Step Guide 

Ready to sign up? Here’s how you can make the smooth transition to EFT/ERA: 

Understanding the Enrollment Process 

The first step in your EFT/ERA enrollment is understanding the process. It typically involves: 

• Choosing a participating payer or clearinghouse 

• Completing an enrollment form 

• Verifying bank account information for EFT 

• Designating a contact person for communications 

Required Information and Documents 

Gathering the right documents in advance can save you from unnecessary back-and-forth. Typically, you’ll need: 

• Banking details for EFT (such as account and routing numbers) 

• Tax Identification Number (TIN) 

• National Provider Identifier (NPI) 

• Contact information for your finance or billing department 

Common Pitfalls to Avoid 

Even the best-laid plans can go awry. Avoid these common pitfalls: 

• Incorrect bank details leading to rejected EFTs 

• Delays due to incomplete forms 

• Communication breakdowns between departments 

It’s all about dotting your i’s and crossing your t’s—attention to detail goes a long way. 

Leveraging Third-Party Intermediaries Pros and Cons 

In the quest for a seamless transition to EFT/ERA, enlisting the help of third-party intermediaries can be a strategic choice. These companies specialize in bridging the gap between healthcare providers and payers, offering expertise to streamline the enrollment process and manage transactions effectively. However, as with any business decision, utilizing an intermediary comes with its own set of advantages and drawbacks. 

Pros: 

• Expert Guidance: Third-party intermediaries are well-versed in the intricacies of EFT/ERA enrollment and compliance, providing valuable insights and assistance to ensure successful implementation. 

• Time Savings: By handling the administrative legwork, these intermediaries can save healthcare providers significant time, allowing them to focus on their core responsibilities. 

• Enhanced Accuracy: With experience in processing payments and managing documentation, intermediaries can help reduce errors that might occur if managed in-house. 

• Scalability: As your practice grows, an intermediary can scale their services to accommodate increased transaction volumes efficiently. 

Cons: 

• Cost: Engaging a third-party service often involves fees, which could impact the overall cost savings of transitioning to EFT/ERA. 

• Reliance on External Parties: Relying on an intermediary means placing trust in an external entity to manage sensitive financial and billing information. 

• Potential Delays: While intermediaries work to streamline processes, any miscommunication or errors on their part can result in delays, much like pitfalls that occur in direct enrollment. 

• Vendor Lock-In: Once a provider partners with a specific intermediary, switching to another service or back to self-management could present challenges and cause disruptions.  

Opting to work with a third-party intermediary involves weighing these factors carefully and deciding based on the specific needs and capacities of your healthcare operation. 

Examples of Third-Party Intermediaries 

Choosing the right third-party intermediary is crucial for a successful EFT/ERA transition. Here are a few reputable companies that provide these services: 

• Zelis Healthcare: Known for its comprehensive suite of payment solutions, Zelis Healthcare offers integrated payment services that enhance speed, accuracy, and transparency. 

• Change Healthcare: This intermediary provides a robust platform with a focus on maximizing efficiency and improving payment processes, catering to both large health systems and smaller practices. 

• Availity: Availity specializes in provider engagement and billing efficiency, offering solutions that streamline administrative tasks and improve financial transactions. 

• Emdeon: With a strong emphasis on connectivity and healthcare payment integration, Emdeon helps manage complex billing processes with ease. 

Selecting an intermediary like these can provide the support and technology needed to navigate the complexities of EFT/ERA enrollment, giving healthcare providers peace of mind and operational efficiency. 

Tackling Enrollment Challenges 

Change can be daunting, but don’t worry. Here’s how to tackle some common hurdles: 

Addressing Resistance and Misconceptions 

Some individuals may be hesitant to switch from paper checks to digital payments. To address common misconceptions, highlight the security features, cost savings, and increased efficiency of EFT/ERA. 

Navigating Technical and Administrative Hurdles 

Technical hiccups and administrative red tape can be frustrating. Consider these strategies: 

• Collaborate closely with IT where applicable to ensure systems are compatible. 

• Foster open communication with payers and clearinghouses to resolve issues promptly. 

• Conduct training sessions for staff to familiarize them with the new processes. 

How EFT ERA Elevates the Payment Game 

With EFT/ERA, the healthcare payment landscape is transforming. Here’s how it’s making waves: 

Enhancing Efficiency and Accuracy 

EFT/ERA improves the speed and accuracy of payments. Billing becomes a breeze, and financial records are more precise than ever before. 

Boosting Security and Compliance 

Data breaches are a real concern, but EFT and ERA come with robust security protocols. Plus, they help you stay compliant with industry regulations. 

Slashing Administrative Costs 

With fewer papers to shuffle and fewer checks to handle, administrative costs shrink significantly. That’s more budget for the things that really matter. 

Real-Life Success Stories 

Here’s where the rubber meets the road. Many providers have already embraced EFT/ERA with great success: 

• Dr. Smith’s Clinic saw payment processing times drop from 30 days to just 7. 

• HealthCo Group reported a 20% reduction in administrative costs after switching to electronic payments. 

• The Care Center improved its billing accuracy by implementing ERA across all departments. 

These examples illustrate how EFT/ERA can transform your organization’s financial operations. 

What Lies Ahead – The Future of EFT ERA in Healthcare 

The world of healthcare payments is evolving, and staying ahead of trends is crucial. Here’s what’s on the horizon: 

AI and Machine Learning Integration 

Artificial Intelligence and machine learning are poised to further enhance EFT/ERA processes, offering predictive insights and automated reconciliation. 

Blockchain for Unmatched Security 

Blockchain technology may soon bring unparalleled security and transparency to healthcare payments, building trust and reliability. 

Real-Time Transactions 

Imagine payments processed in real-time. The future of EFT/ERA could very well include seamless transactions that happen instantly. 

Wrapping It Up: Take Action Today 

In a world where time is money, EFT/ERA enrollment offers healthcare providers a golden opportunity to streamline their payment processes. By understanding the enrollment process, tackling common challenges, and recognizing the benefits, you’re well on your way to a more efficient and profitable operation. 

Don’t wait. Take action today. Investigate your options for EFT/ERA enrollment and bring your payment processes into the modern age. For more information and support, consider reaching out to industry experts who can guide you through the transition smoothly. 

Ready to revolutionize your payment systems? Say goodbye to the old ways and hello to the future of healthcare finance with EFT/ERA enrollment. 

Let’s paint a scenario: You’re a healthcare provider out of network with an insurance company. Your patient has out-of-network benefits, but here’s the kicker—the insurance company sends the check directly to the patient. Frustrating, right? Don’t worry, we’ve got a guide to help you navigate this tricky situation and recover the money owed to you.

Step-by-Step Process for Recovering Money from Patients

1. Verify Insurance Coverage

Before you even start treatment, verify that the patient has out-of-network benefits. Understand the coverage details, including deductibles and co-insurance. This knowledge is crucial in setting clear expectations.

2. Transparent Communication

Have an open conversation with the patient about their financial responsibility. Explain what the insurance company covers and what they will owe directly. Trust me, clear communication here can save a lot of headaches later.

3. Documentation

Keep meticulous records of the treatment provided, the amount owed, and any communication with the patient or insurance company regarding payment. Documentation is your best friend.

4. Billing the Insurance Company

Submit a claim to the patient’s insurance company. Make it clear to the patient that you are an out-of-network provider and list the services provided. This ensures there are no surprises on either end.

5. Check for Errors

Regularly check the status of your claim. Ensure there are no errors and that it is moving through the payment process smoothly.

6. Check Mailing Address

If the insurance company sends the payment directly to the patient, make sure they have your correct billing address. This way, the patient knows where to forward the check.

7. Follow Up with Patient

Once you confirm via the insurance portal or clearinghouse that the check has been sent to the patient, follow up promptly. Request payment and offer multiple options for how they can make the payment—online, over the phone, or by mail. Flexibility can make a big difference.

8. Payment Plans

If the patient struggles to pay the full amount out-of-pocket, discuss setting up a payment plan. Find a solution that works for both parties. Compassion coupled with persistence can go a long way. Payment plans are not offered when the insurance company has sent the payment to the patient.

9. Legal Options

If all else fails and the patient does not make arrangements to pay, consult with a legal advisor. Explore your options but remember to keep this as the last resort.

10. Persistence

Maintain open lines of communication and be persistent in your efforts to recover the funds. Follow up regularly and keep the conversation going.

Real-World Scenarios to Illustrate the Process

Scenario 1:

A patient with out-of-network benefits undergoes a session with a therapist. The insurance company processes the claim and sends a check directly to the patient. The patient promptly informs the therapist. The therapist follows up with the patient, requesting to forward the check or bring it in person. The patient complies, and the therapist processes the check.

Scenario 2:

In another instance, a patient receives a check from their insurance company and forgets to inform the provider. After a month, the provider reaches out for payment, and the patient realizes they received the check but forgot to forward it. The patient immediately sends the check to the provider, who then processes it.

These scenarios highlight the importance of clear communication, documentation, and persistent follow-up to ensure timely recovery of owed funds.

Final Thoughts

Recovering money from patients when out of network can be challenging but not insurmountable. By following these steps and maintaining a proactive approach, healthcare providers, medical billing staff, and practice managers can navigate these tricky waters effectively. Your persistence, coupled with clear communication and thorough documentation, will ensure you recover the funds you’re due.

Got any other tips or experiences to share? We’d love to hear them in the comments below. And if you found this guide helpful, why not share it with your colleagues?

Stay persistent and stay informed!

Mental health is a critical aspect of an individual’s overall health and well-being. However, it can be challenging to get the right treatment, especially when it comes to billing claims. Denials of mental health billing claims have become more common, preventing patients from getting the care they need. When billing claims are denied, it creates more than just a financial burden; it can also cause patients to lose access to treatment and compromise their recovery. In this blog post, we will look into the top 10 reasons why mental health billing claims can get denied and how they can be prevented.

1. Inaccurate or Incomplete Patient Information

One of the reasons why mental health billing claims get denied is when patient information is inaccurate or incomplete. This includes missing or incorrect personal information, such as dates of birth, contact details, and insurance information. Providers must ensure that patient information is complete and accurate to avoid billing issues.

2. Lack of Medical Necessity

Insurance companies often deny claims when they do not believe that a service or treatment is medically necessary. Providers must document the medical necessity of any service provided and ensure that it aligns with the patient’s condition and diagnosis.

3. No Referral or Pre-Authorization

Insurance companies may require a referral or pre-authorization from a primary care provider before they cover certain mental health services or treatments. Providers should ensure they have obtained the necessary documentation before rendering any services or treatments to avoid denials.

4. Incorrect Billing Codes

Billing codes determine the charges for rendered services or treatments. If the wrong codes are used, it can lead to billing claim denials or potentially delay payment. Providers must ensure they are using the correct billing codes that align with the provided services and treatments.

5. Time Limit Exceeded

Providers have a limited amount of time to submit billing claims to insurance companies. If the provider misses the filing deadline, it can cause a rejection or delay of reimbursement. Providers must send out billing claims within the permitted timeframe to avoid denials.

6. Claims Exceeded Allowed Services

Insurance companies have pre-approved limits for certain mental health services or treatments. If the provider exceeds the allowed limit, it could lead to a denial of the billing claim. Providers should ensure that they follow the pre-approved limits to avoid claim denials.

7. Billing for Inappropriate Services or Treatments

Providers must make sure the services or treatments they bill for align with the patient’s condition and diagnosis. Trying to bill for inappropriate mental health services or treatments may trigger denials by insurance companies.

8. Using the Wrong Modifier Codes

Modifier codes provide additional information about the services or treatments that the provider delivers. Providers must ensure they use the right modifier codes to avoid billing claim denials.

9. Balance Billing

Providers may sometimes want to bill the patient for the balance of an amount that insurance does not cover. This is against insurance rules and can lead to claim denials. Providers must understand the policies of an insurance company and avoid balance billing.

10. Inadequate Documentation

Providers must ensure that they fully document the services and treatments rendered. Lack of adequate documentation may signal an insurance company of fraudulent activities, leading to claim denials.

Conclusion:

Billing claims denials can be frustrating, both for providers and patients. However, understanding the reasons why mental health billing claims get denied is essential to avoid them. Providers must ensure they provide accurate billing information and adhere to insurance policies and guidelines. By doing this, providers can avoid claim denials and help patients receive the care they need. Always remember these top 10 reasons and their corresponding preventive measures to avoid billing claims denials.

By Chandresh J. Shah

Growing a practice can take a lot of work and having goals can help. That is why it is important to have KPIs(Key Performance Indicators) that can be used to determine how well practice goals are being met.

Let me share to you KPIs that will help your practice on 4 main areas:

1. Front Desk 
2. Clinical
3. Billing and Revenue Cycle Management
4. Reputation Management

Let me begin with KPI’s for Billing and Revenue Cycle Management as they are the first point of contact and impression your practice makes with existing and new patients. These KPIs are:

14. Net Collections Rate

15. Total Operating Margin

16. Average Insurance Claim Processing time & cost

17. Average cost per patient

18. Claims Rejection rate

19. Average insurance claim processing time and cost

20. Average Treatment Charge

21. Percentage of Patients without Medical Insurance

22. Time Gap between Date of Service and Date Billed

23. Percentage of Claims Denied overall, and by Payer

24. Percentage of Claims Denied due to Front-end errors vs Coding oversights

25. Percentage of Patients with Public vs Private Insurance

26. Percentage of No-Response claims overall, by Payer

In the video below, I went through and explained what each KPI meant for the Billing and RCM. You can also download the guide through this link (Click Here):

By Chandresh J. Shah

Growing a practice can take a lot of work and having goals can help. That is why it is important to have KPIs (Key Performance Indicators) that can be used to determine how well practice goals are being met.

Let me share to you KPIs that will help your practice on 4 main areas:

1. Front Desk 
2. Clinical
3. Billing and Revenue Cycle Management
4. Reputation Management

Let me begin with KPI’s for Front Desk as they are the first point of contact and impression your practice makes with existing and new patients. These KPIs are:

1. Patient In-Office Wait Time
2. Schedule Density
3. Percentage of Electronic Health Records
4. Confirmation and No-Show Rates
5. Patient Phone Wait Times
6. Check-In Efficiency
7. Number of Patients Served Per Month
8. Number of New Patients Served Per Month
9. Number of Patient Referrals
10. Staff Time Spent Entering Data/Charting
11. Doctor-Care-to-Paperwork Ratio
12. Percentage of Patients Who Found Paperwork to be Clear and Easy to Understand
13. Patient Care Automation (i.e. paper work required)

Watch this “Top 40 KPI” video as I went through and explained what each KPI meant for the front desk. You can also download the guide through this link (Click Here):

By Chandresh J. Shah

A medical practice may seem like a ‘routine’ business. However how many times have you said – “My practice is different from others”’? It is because every business owner and founder has a vision that you believe should set apart your practice from others. There is a reason why you are independent and don’t join a large hospital. It is this vision that must be articulated and passed on.

In a practice, we encounter different kinds of employees. Of course, we would want to have employees worth keeping. What characteristics of employees should you look out for? If your practice has employees that have these characteristics, consider yourselves lucky:

Committed
Innovative
Passionate
Smart
(They) Hustle but they are able to estimate the right amount of push you and others need.

Why are these characteristics a winning combination for a practice? It is because employees with these characteristics are Entrepreneurs.

Good Employee vs. Entrepreneurial Employee

The Good Employee

Most employees qualify as ‘good’ because they do their tasks well; tasks that fit into the overall vision of the founder/provider/owner. They hone in well on their particular function. These people are essential to making a business work well.

But these are not the kind of people suited to take over the entire operation. Many employees have a title that suggest they are senior and therefore are leader. That is not necessarily true.

For Doctors and providers running and managing their own practice hiring an entrepreneurial employees can be risky. That is because employees with characteristics listed above can be unwieldy and intimidating. They can and will exert their dynamic pace of action and thought.

The Entrepreneurial Employee

How do you identify these entrepreneurial employees?

They have tremendous energy. Not just during the first few months of hiring, but always – like an energizer battery. They not only work hard, they hustle. They impress with intensity.

Commitment to personal improvement. You may find them reading self-improvement books, taking evening or online courses, subscribing to personal improvement blogs. It is ambition that drives them but not just for pure ambition of climbing ladders, but personal improvement. This can lead to benefits that the practice will gain from.

They don’t like being micromanaged. Entrepreneurial employees should be ‘handled with care’. You – the practice leader – can encourage or inhibit entrepreneurial behavior. If you manage employees too closely (micromanage), creativity and entrepreneurial behavior will be stifled. Conversely, they will flourish. Entrepreneurs need space to think and create. Remove boundaries and perceived limits.

They share their plans and ideas proactively. Don’t consider this as someone trying to get close to you and impress you. They may have ideas about growing the practice, increasing patient satisfaction, increasing online reviews, increasing patient collections, and overall practice efficiency.

They want to get things done – not just talk about it. Entrepreneurs are doers and thinkers. Their thinking is done not just when you ask them but it is done way in advance. They want to act on those ideas. Many entrepreneurial employees get fidgety in meetings, get impatient because they want action not just talk in meetings.

They may threaten to leave if they are not thriving. This is the downside of hiring entrepreneurial employees. They want to see growth and success and be instrumental in making it happen. It is up to you to create an environment where they thrive. Share your vision and work to have them make it their own. If there is a disconnect, this employee is perhaps not a good fit.

They may not be excellent team players. Sometimes, the most entrepreneurial employees don’t work well on teams. They don’t think like other people, and may have trouble understanding or empathizing with alternate points of view. These are not bad team members, their entrepreneurship needs to be harnessed.

Working with an entrepreneurial employee

I was helping a good friend and client several years ago. His practice was struggling to grow. He had just lost a provider/partner. One of his employees did not have the ‘office manager’ title, but she acted and behaved like one. She was a hard charger and driver. She intimidated everyone, but at the same time, other employees respected her for her knowledge and tenacity. They implemented a new EHR. She learnt and mastered it to the point where she became the internal ‘guru’. Even billing staff reached out to her.

The owner provider was concerned and scared. He was contemplating letting her go because even he felt intimidated. We talked it over and established a 6 month plan. We gave her a vision for personal and practice growth, and linked them together. We established boundary conditions and left her alone without micromanaging. We met with other staff members and sought out their feedback and articulated her role.

After 6 years, she is the office manager – she’s happy and the practice has grown tremendously.

Recognize and seek out entrepreneurial employees, you will not regret it.

Let me know if I can help. Pick a time on my calendar to discuss ideas. (Give it a few seconds for calendar to load after you click)

By Chandresh J. Shah

I’m sure you all have heard about the term word-of-mouth marketing.

Getting people to talk often, favorably, to the right people in the right way about you and your practice is far and away the most important thing you can do for your practice. This is the essence of word-of-mouth marketing.

As the topic interested me, I have been reading a book – Talk Triggers, by Jay Baer and Daniel Lemin.

There is a very interesting case study. He mentions Dr. Glenn Gorab, an oral surgeon in Clifton New Jersey. Dr. Gorab started doing something more than 15 years ago. He created a differentiator that other providers don’t seem to copy or follow despite its success as a word-of-mouth generator.

In the book, Dr. Gorab says, ‘I’ve actually mentioned this approach to several of my referring dentists, and none of them implemented it,”.

Dr. Gorab’s approach

Every weekend Dr. Gorab calls each patient that is coming to the office for the 1st time the following week. His typical greeting is as follows: “Hi, this is Dr. Gorab, I know we have an upcoming appointment for you next week, I just wanted to call to introduce myself and ask if you have any questions prior to your appointment.”

Dr. Gorab says patients aren’t really sure what to make of the calls because they are so unexpected. “Most people are shocked that a doctor would call them prior to their appointment; they are almost dumbfounded. It’s so out of the ordinary. They say: no one has ever done this to me before.”

These patients tell their friends about Dr. Gorab’s calls, and they deliver new patients through his front door on a consistent basis.

He says 80% of patients mentioned the calls once in the office for their appointments.

Quite literally, every physician-every professional service provider, could mimic it, yet they do not. Why?

An interesting side benefit. Medicine is incredibly litigious in the United States and has been for decades. 99% of high risk surgical specialists will face a patient lawsuit during their career. Oral surgeons are similarly at risk for legal proceedings, but Dr. Gorab has avoided them entirely across his 32 year career.

“I have never been sued for anything,” he says.” And I do surgeries; I do surgery every day. I have complications. Some of them have been at complications. But probably the reason why I haven’t been sued is because people understand that I care about them, and people don’t sue people they like. The fact that I care about people is the biggest determinant of that, and the fact that I call them ahead of time means that I’m taking an interest in them and I care about them. So right from the start, they see that I care about them.”

Are you ready to try this approach?