|Take advantage of the fact that the majority of practice management software programs have electronic claim components already included or available at minimal cost, and experience improved efficiency, increased practice profitability, and better patient care. |
“An ECP that does not utilize an integrated electronic claims function is placed at a competitive disadvantage,” said Floyd Webb of Healthline Systems Inc./Eyecom. “With an integrated approach, all claims for all insurances are generated directly from the practice management software into one file that is sent over a secure HIPAA-compliant file.”
Sounds like a no brainer to switch to e-claims, right? Nonetheless, you may still have a few concerns before you jump on the e-claim bandwagon. Here are a few answers to your last-minute questions.
Q: Will e-claim software help my staff code office visits?
A: The electronic claims software available today automatically allows optometric practices to code office visits and prepare claims submissions, plus it provides management reporting to monitor receivables.
One example is First Insight’s maximEyes. Once you complete an exam, the maximEyes Evaluation and Management (E&M) Code Checker reviews EMR data, then instantly suggests a billing level that is compliant with Medicare’s E&M standards. maximEyes also assists doctors by recommending pre-set CPT codes (see below for more information) based on diagnoses and allows the eyecare professional (ECP) to prioritize these codes for documentation and insurance submission purposes. ECPs can analyze every patient exam and select accurate diagnosis and procedure codes based on their findings, eliminating the need to search for codes at the end of the exam.
But Alistair Jackson, MEd, of EMRlogic Systems Inc., reminds ECPs to still respect ethical and professional lines. “Software is entirely capable of doing all the billing and coding by counting clicks and assessing codes,” he said. “If software can do this, who needs a doctor? Software must not replace a doctor’s professional judgment. It can legitimately inform the process of clinical decision making, but it must not go all the way.” EMRlogic’s OD Professional™ provides an informational summary, but the final assessment is done by the ECP.
Q: What are CPT and ICD-9-CM codes?
A: CPT, or Current Procedural Terminology, codes are published by the American Medical Association. The purpose of the coding system is to provide uniform language that accurately describes medical, surgical, and diagnostic services. ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification) coding system is used to code signs, symptoms, injuries, diseases, and conditions. In other words, ICD-9 is used for diagnosis, and CPT codes are procedural. The critical relationship between an ICD-9 code and a CPT code is that the diagnosis supports the medical necessity of the procedure.
Crowell Systems’ Medformix, EMRlogic’s OD Professional, and First Insight’s maximEyes all have the ICD-9 and CPT codes preloaded in addition to the other widely used optometric/ophthalmic diagnosis codes. Compulink Business Systems, Inc.’s Eyecare Advantage™ also comes pre-populated with tables of sample data that includes most of the CPT codes a practice would need. Additional codes can be easily added.
Q: What happens if my system fails? How is information backed up?
A: ECPs are always strongly encouraged to routinely back up their system to ensure data integrity and availability.
Donna Lehmann from First Insight recommends backing up via removable media to an off-site electronic storage facility, or through an online backup partner, such as DataHEALTH, which specializes in data backup, storage, and recovery systems. “Backing up your data is the least expensive insurance policy you will ever have against hard drive crashes, fire, flood, vandalism, human error, and more,” she said. “Without a recovery plan there is no guarantee that your data backup will make it through the recovery process.”
Q: What does a clearinghouse do?
A: Because it’s too labor-intensive for a single practice to submit claims to each individual payer separately, clearinghouses provide a secure single point of entry to transmit all of a practice’s electronic claims to individual insurance carriers. In most cases, the claims are simply batched within the software and sent directly from the software to the clearinghouse at the end of the day.
One of the most important functions a clearinghouse does is scrubbing the claims to check for errors. If there are errors on the claims, the clearinghouse provides an electronic report to the practice within 24 hours, and in some cases, just a few hours, before they are sent to insurance carriers.
Software from Crowell uses the clearinghouse Emdeon, which allows a practice to download a report of the previous day’s claims. The report is an amalgamation of all of the reports Emdeon receives from the various insurance companies and tells whether or not the claim has been accepted for processing. If it hasn’t been accepted, the detail of the reason why it was rejected is provided.
Offered as an optional service to Eyecare Advantage, Compulink’s Emdeon Revenue Cycle Management includes Emdeon eClaims, Remittance, and Real-time Eligibility Verification to allow practices to send both Professional (CMS-1500) and Institutional (UB-04) claims to payers electronically in a HIPAA-compliant format, automatically post insurance payments and adjustments to patient ledgers, and verify insurance eligibility in real-time.
Changing your whole billing process can seem daunting at first, but with all the support software manufacturers provide for a seamless transition, you’ll be wondering why you didn’t jump on the e-claim bandwagon sooner.
Marian Zboraj is Editor of Vision Care Product News. Contact email@example.com with comments and/or suggestions for future topics.
PRACTICE MANAGEMENT SOFTWARE WITH E-CLAIM CAPABILITY