ERA: WHAT IT IS AND HOW YOUR PRACTICE CAN BENEFIT
The Prospective Payment System (PPS) is a payment model developed by the Centers for Medicare and Medicaid Services (CMS) to encourage healthcare providers to maximize their earning potential on every Medicare and Medicaid paid service only by decreasing the number of services delivered on a net basis. PPS pays providers predetermined, fixed payments based on specific patient classifications, like diagnosis, making the healthcare industry cumbersome and expensive when administrative tasks take too long. Electronic Remittance Advice (ERA) answers this by automating payment processing and simplifying revenue cycle management.
Replacing manual processes with automated systems will reduce errors, save time, and improve operational efficiency. It shrinks administrative headaches by streamlining decision-making with better data usage. It drastically enhances patient care as providers can direct their attention away from paperwork and toward delivering high-quality patient care. The intent behind these payments is to pay for the operating costs and some capital costs of giving care less erratically and more consistently. By contrast with the customary fee-for-service model, which conditions payment rewards according to volume delivered, PPS is geared toward rewarding efficiency and efficacy in cost.
What are ERAs?
An Electronic Remittance Advice (ERA) is otherwise known as a HIPAA 835 file, it is an electronic Explanation of Benefits (EOB). They give details like payment or denial of the claim status, related final claim resolutions, or payer offset against the charges submitted.
Why should we use ERA?
It is a time-consuming and, thus, expensive task to post payments and reconcile patient accounts manually. Recent research has revealed that an average doctor takes about five hours per week on administrative or non-clinical work. This is equivalent to 3 weeks of billing and insurance-related tasks.
Non-standardized EOB formats and claims adjudication codes from various payers make manual entry of payments difficult. Moreover, there are very high data entry mistakes when processing EOBs. If your employees mistakenly enter $20.00 instead of $200.00, they must search the entire batch for the error.
Physical storage inefficiencies and difficulties accessing documents are other causes of concern about EOBs. It does not sound efficient when investigating and handling secondary claims by delving into paper archives.
Most importantly, one fail to enjoy the benefits of big data. Providers lacking a central data warehouse cannot properly utilize their payment information or denials to help them make better business decisions.
How ERA Benefits Your Practice
ERAs were created to address the high administrative costs of healthcare, the increasing volume of transactions, and the rising demands for compliance. They automate processes and speed up the revenue cycle, significantly decreasing the time required for data entry, payment verification, and posting work. Your practice should have a system capable of accepting ERAs for review denials and running real-time analytics on the revenue cycle.
What Do You Need?
You need a system that can:
- Receive ERA 835 files
- Distinguish between paid and non-paid
- Arrange denials in one app
- Conduct real-time analytic reports
A vital analytics tool combined with ERA can enhance your efforts to identify underpayments through claims. Looking closely at denials will result in an increased first-pass resolution rate, improved collection efforts, and reduced future denials, adding value to your practice.
Conclusion:
The transition to Electronic Remittance Advice (ERA) can significantly affect how your healthcare practice handles administration tasks, especially those linked with processing payments and managing revenue cycles. ERAs could considerably reduce the time and money spent on manual data entry, lessen mistakes, and improve work process efficiency. This modification would aid by making operations more effective and permitting better utilization of big data for decision-making and patient care enhancements. Taking up ERA technology is not just a tactical action. It also has the potential to generate significant monetary savings, lessen administrative load, and create an optimized healthcare delivery system.
