The Digital Age of Billing
Since the establishment of insurance companies, the process has evolved to keep up with ever-developing technology. Today, there are many digital products and services that have been developed within the insurance industry to make the billing and credentialing process slightly easier! As usual, there is a little bit of a learning curve that comes along with change, so we thought that we would talk about some of the technological advancements, some of the strengths and weaknesses of each, and where applicable we will discuss the older counterpart.
One of the greatest advantages of the digital age is the ease with which we can store and access information. No more bulky filing cabinets storing patient information, outdated phone books and directories, or rifling through piles of documents looking for the correct information. Databases allow us to easily store, search, and retrieve information, all at your fingertips and as compact as your preferred device!
Electronic Health Records (EHR)
The EHR has transformed the healthcare industry, simplifying many of the paper processes that were previously time consuming, monotonous, and had a large amount of room for error. Patient data can now be stored behind password protection, and as long as all information is stored correctly can easily be used to auto-fill claim forms. Spending time filing paperwork is a thing of the past thanks to the EHR. There are also cloud based EHR systems such as TherapyNotes which allow you to login to your system from any device, anywhere you are working. This, along with the advent of telehealth, could allow you to travel and work!
There are barriers to entry for using an EHR system, however the barriers are low and there are many more advantages to using an EHR than disadvantages. Transitioning to an EHR can be time consuming if you are coming from a paper filing system, as all of the information will need to be input by hand, or into a spreadsheet to be uploaded into the system. Learning to operate the system can be challenging if you don’t consider yourself to be computer savvy, but most EHR companies have support teams that can talk you through how to use their system, or they have recorded tutorials that you can watch at your own pace. One of the reasons that we recommend TherapyNotes is because of their excellent support team, answering support calls in under a minute and boasting an extensive library of video and written tutorials!
Your CAQH profile can be thought of like a Facebook page that only insurance companies look at. In order to get credentialed with an insurance company, you will need to have a profile created with CAQH (Council for Affordable Quality Healthcare). CAQH is a non-profit organization that was established to try and streamline the insurance industry, and bridge gaps between providers and the insurance companies. Your CAQH profile will include all of your important identifiers and demographic information, which can then be accessed by an insurance company. Having your information input into this provider database will reduce some of the paperwork that was previously necessary to credential or update your information with an insurance company.
Remembering to update this information can be difficult if you are not in the rhythm of checking in with this profile, however keeping your profile up to date is an important step in ensuring that your claims process properly. A good rule of thumb is to set a calendar reminder once per quarter to log in to your CAQH profile and check that all information is accurate. This way, you develop a routine, and your information is more likely to be up to date when you do find the need to credential, or re-credential with an insurance company.
This database is used to store provider information, primarily NPI data. When you apply for an NPI, your information is logged in the NPPES website. If you ever need clarification on your NPI number, and whether it is a Type 1 or Type 2 NPI number, you can use this website as a reference. This site also stores address and organization information for your practice. If you make any changes to your address or organization, NPPES should be notified within 30 days of the change.
Availity offers many different services, including serving as a provider portal for many insurance companies, operating as a clearinghouse for claims, and as a source for news and updates in the insurance industry. If an insurance company uses Availity as it’s provider portal, you can view and follow up on claims in this system. Availity also puts out a lot of valuable content pertinent to the industry. Whether or not you have an account with Availity will depend on whether or not you work with an insurance company that uses Availity, however we recommend that you familiarize yourself with them and their content as they are a large player in the insurance billing industry.
Submitting claims has become easier and takes less time than it used to due to the advent of electronic claims and remittance. Below is an overview of the electronic billing process, but we dive deeper into the details and importance of EDI and ERA in another article. Embracing the digital billing process can save you a lot of time, a lot of paperwork and may ultimately decrease the chances of denied and rejected claims.
By establishing an Electronic Data Interchange (EDI) between your EHR, a clearing house, and the insurance company that you are submitting claims to, you can submit claims electronically directly from your EHR. This method is becoming more standard for all insurance companies, and it can help save you time. Patient data and insurance information gets pulled directly from your EHR onto the claim form, so as long as all of the information in your EHR is correct claims can be created quickly! The clearinghouse double checks your work through the process of claim scrubbing, and also ensures that HIPAA guidelines are met when claims are submitted.
You can also enroll for electronic remittance advice, or ERA, and receive a digital form that includes information about which claims were paid, or which claims were denied or rejected. This file can be directed right to your EHR, which can save time when it comes to posting payments, or following up on unpaid claims.
Many insurance companies are offering electronic payment services, which allows you to get a direct deposit from the insurance company into your bank account. No more waiting for paper checks! Electronic payments
Payer Portals for Providers
Portals vary based on insurance company. Some use a third party portal, such as Availity, and some insurance companies have developed their own portal system in-house. When you credential with an insurance company, they should provide you with instructions on setting up any portals. This may involve creating an online account, or using a username and password provided by the insurance company to access an account that they created for you. The portal is meant to be a place where you can view any claim activity, and follow up on claims that have been submitted. It is also a method that the insurance company will use to distribute information. They will often have updates for providers on their systems and processes, guides for submitting claims, and you may even be able to access your fee schedule information from this portal. Portals can be a great resource for providers, and we recommend that you establish and check in to your portal account regularly.
The Changing Landscape
Technology changes quickly, and insurance companies are constantly adapting. The best way to keep up with these changes is to be sure to thoroughly review any email and mail updates from the insurance companies that you are credentialed with. You can also check if they have additional email lists that you can subscribe to for information.
There is a lot to learn and manage when it comes to digital billing. If you’re feeling overwhelmed by all of the acronyms, accounts, and steps to submit a claim, consider signing up for Practice Solutions’ billing services. We take over the time-consuming billing process, and work to help you understand the system. If you would like more information, please fill out the contact form on our website, give us a call at 734-437-9432, or email us at email@example.com.