Tracking Claims Operation Guides (The American Medical Association (AMA))
Tracking Claims can be used by physician practices. They can submit and resubmit large quantities of claims at one time, in bulk, quickly and efficiently. For example, if categories such as a specific date of service, a date range or a specific patient’s claims are required by the payer to be resubmitted, the practice management system or transmission vendor may be able to quickly sort and resubmit these claims. The categories can be resubmitted to the payer in a bulk file without taking up valuable staff resources and time searching, sorting and resubmitting manual claims. Concurrently, health plans will save on the administrative costs generally associated with the manual processing of resubmitted claims. Physician practices may consider automating their claims revenue cycle by requesting that EOBs be delivered electronically and that claim payments be automatically transferred through an electronic funds transfer (EFT) by a payer and deposited into the physician’s designated bank account. An electronic EOB in the mandated standard format can be posted into the physician’s system with little or no staff intervention. An electronic EOB is also known as an electronic remittance advice (ERA). Several payers offer EFT programs, which, in contrast to paper checks, use electronic means to transfer monies between parties. EFT payments can be nearly instantaneous (avoiding postal delays) and may reduce administrative steps associated with issuing or depositing payments. However, physician practices need to fully review the EFT program to determine if the prospective program provides enough flexibility for the physician to maintain banking relationships.
Effective January 1, 2014, all health plans are mandated to offer EFT to any provider that asks for it for their claim payments. The potential elimination of manual processes from the claims management cycle through the introduction and use of HIT solutions may allow physician practices to increase their focus on auditing, appeals and collection of claim payments from payers. By streamlining the manual processes, physician practices can help ensure that the practice is performing revenue enhancing functions, such as making sure the appropriate reimbursement for providing medical services and procedures is received from patients and payers.