New technologies from the cloud to virtual assistants are transforming the way provider offices operate. As the health care industry strives for greater efficiencies and adopts sustainable measures, submitting medical claims on paper seems to be a thing of the past. A less costly and fast solution has emerged that is paving the way for a completely paperless claims process: electronic attachments. And although only a portion of medical claims actually requires supporting documentation, even the providers who consider themselves completely on board with meaningful use and EHR are still submitting attachment requests manually. In order to remain viable in an evolving industry, the use of electronic attachments is a quick fix to mitigating rising costs.
Surprisingly, the dental industry is leading the way by adopting the electronic attachments process. An EmblemHealth case study states that the dental industry has reaped the benefits by:
- Eliminating the loss of records with digital tracking abilities.
- Eliminating wasted efforts with digital storage, processing, and submission.
- Increasing acceptance by allowing dentists to use their existing technology.
Because of the strong results from the dental claims side, EmblemHealth is in the process of implementing electronic attachments into their medical operations.
Not only are the electronic attachments more time and money efficient, they are more secure. Claims won’t get lost in a pile of paperwork and documents will be readily available only to those who need to review them. These benefits are proven and measurable, and deserve a close evaluation by payors and providers.
Additionally, government mandates are increasing the need for electronic attachments like the 275 mandate, RAC audits and more. The 275 Mandate is poised for release as early as 2014, and is the first government mandate that will require payors to accept certain claim attachments electronically, including:
- Emergency department
- Rehabilitative services
- Lab results
- Clinical notes
This is just the beginning. The 275 standards are a good indicator of future mandates that will eventually require payors to accept all claim attachment types electronically.
Another government influence, the implementation of CMS’s RAC audits, has increased the number of document requests that a provider is responsible for. Since RAC is designed to identify over and under-payments on previously processed claims, there are a large number of claims that must be resubmitted with additional supporting documentation. These increased requests for supporting claim documentation can be overwhelming for the provider in terms of administration time and costs, and as of November 2010, limits have been put in place to cap the number of records requested by auditors in a 45-day period to ease the burden. But for a provider who uses electronic attachments, the process can be as simple as one click of the mouse.
Electronic attachments can also assist a provider in meeting their meaningful use requirements. In order to meet the requirements, the provider must show that they are using EHR technologies in certain measurable ways. Not only are electronic attachments a much simpler way for a provider to submit supporting documentation, the use of electronic attachments fits with other EHR initiatives, and helps providers meet the requirement that at least 80 percent of their claims are filed electronically. If the claim is filed electronically, but the attachments are not, the claims process is inherently slowed down.
The health care industry has evolved carefully, embracing digitization slowly. Providers have often discounted the need for electronic attachments, citing that they are only used in such a small portion of medical claims. With the onset of new government requirements, it is becoming increasingly apparent that the use of electronic attachments is not an obstacle, but just the opposite. The things that used to take time to file, fax, and mail are now made available easier and most importantly, faster with electronic submissions.
Melinda (Lindy) H. Benton is CEO of EA Holdings, which includes National Electronic Attachment, Inc.(NEA) and Medical Electronic Attachment, Inc.(MEA). NEA defined the electronic attachments process for the dental insurance industry and maintains an enviable 98% market share in the electronic attachment field. Clients include hundreds of Blue Cross/Blue Shield affiliates, United Healthcare, Aetna, Humana, Regence and many more. Prior to NEA/MEA, Lindy served as Divisional Executive at The Sage Group managing a $350 million division with 1,400 employees, which she led to record-breaking quarters of revenue growth and operational excellence in less than a year. Lindy serves on the Advisory Boards for several Health IT and Capital Investment companies, working with executive teams to drive both acquisition and organic growth strategies in North American and global markets. Lindy is also a member of the Foundation Board for Florida Disney Children’s Hospital and serves on executive councils for several health related committees and industry associations. www.mea-fast.com
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