Product Cuts Claim Denials, Boosts Payment from Insurers

Electronic claims system may help laboratories collect more dollars from CDHP-insured patients

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ONE CONSEQUENCE OF THE GROWTH of high-deductible health plans and health savings accounts (HSAs) is that clinical labs and pathology groups need to collect larger amounts directly from patients.

As predicted by THE DARK REPORT last year, bad debt levels are rising in communities where enrollment in high deductible health plans has been significant. (See TDR, August 1, 2005.) In some cases, the laboratory must collect the full amount from the patient.

Now comes news of nationwide availability of an electronic system that facilitates real-time enrollment verification and delivery of claims. Such a system is a benefit to labs and pathology groups because it makes it feasible to verify eligibility and settle claims with the patient at the point of care.

Claims Management

The system is called EnterpriseEDI and is a health insurance claims and revenue cycle management program. The software is available as an application from Companion Technologies, in Columbia, South Carolina.

It is an ASP (application service provider) arrangement where the software resides remotely and customers access it via the Internet. The system offers pathologists, labs, and other physicians a way to forego a substantial investment in hardware and instead utilize software as a service (SaaS).

EnterprisEDI allows physicians to process and transmit all payer claims directly from a desktop computer. The system performs compliance and eligibility checks to reduce denials. It also tracks claims status, highlights errors, allows for claims correction with minimal data entry, and automatically generates patient correspondence.

“It works with a billing system, so a lab or a pathologist would use a billing program to generate claims and our software would capture those claims and edit them to make sure they go to insurers expeditiously,” said John Tempesco, Senior Vice President for Companion Technologies.

“The system helps to reduce billing cycle time by about a third,” Tempesco said. “Medical labs generally have many relatively small claims compared with that of other typical practices. So, a program that allows practices to see claims status quickly provides significant benefits. With EnterprisEDI, pathologists will not lose claims in the system and fewer claims will be rejected because the system identifies errors before they go out.”

THE DARK REPORT observes that, as more patients are enrolled in high deductible health plans and HSAs (health savings accounts), labs and pathology group practices will benefit from more aggressive use of software tools such as EnterpriseEDI to improve billing and collections.


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