Healthcare providers have long been challenged by the process of collecting payments for services rendered. Providers collect patient co-pays at the point of service in the form of cards, checks, and cash, as well as reimbursements from insurance companies — generally before they prepare and submit invoices to patients for final amounts owed.
Complicating matters further is that many insurance companies remit payments by check with the explanation of benefits (EOB) statements attached in a non-standard format. Providers have to review and reconcile this claim detail before they manually post these payments to their practice management system. Subsequently, they may have to submit secondary claims for supplemental insurance, which can be labor-intensive as they attempt to redact information from the original EOB for re-submission.
"Healthcare providers suffer from a lengthy and paper-intensive receivables process where the collection cycle often averages 60 to 120 days," says Karen Doyle, a Senior Product Manager for Treasury Management Services at First Tennessee Bank. "In addition, the previous lack of defined standards for how claim settlements were disclosed in EOBs required extensive training of back-office personnel to interpret and reconcile claim detail from various insurance companies."
Over the last few years, updates to legislation, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA), have standardized much of this process.
First Tennessee Bank responded to these updates with a comprehensive suite of services led by its Healthcare Lockbox portal. Healthcare Lockbox takes remittance payments received from insurance companies (paper or electronic) and puts them into an industry-standard format that can be viewed through a secure Web site and electronically transmitted for automated posting to the provider's practice management system.
Healthcare Lockbox also supports workers compensation claims and will soon support pharmacy claim payments. Providers that implement this image-based process benefit from:
- Claims automation. The Explanation of Payment and Electronic Remittance Advice details are converted into a standard, easy-to-read format, which eliminates hours of training staff to interpret forms received from different insurance companies.
- Better use of staff time. Clients receive a balanced file ready to post, which eliminates hours of manual processing time that can be reallocated to other responsibilities (i.e., working the denied claims to get them resolved and paid) or used to generate an expense reduction.
- Reduced paper documentation costs. Supporting documentation received through the lockbox is imaged, indexed, and accessible up to seven years online. This eliminates back-office costs associated with document filing and retention, and secures patient information.
- Time-saving search tools. Transaction details are searchable online by payee, claim, or service-level detail. Providers can also receive image files via CD-ROM, DVD, or electronic file delivery to feed into their internal systems.
- Less revenue leakage. Denial reporting and quick access to zero-dollar claim payments enable providers to review information quickly to determine their next course of action.
Customize your lockbox
Several customization options are available to match the right services to the right clients. One example is our Miscellaneous Correspondence option that helps providers more efficiently handle documents received from payers such as denial, pre-certification, or appeal letters unaccompanied by a claim payment.
"It can be a time-consuming task weeding through miscellaneous documentation trying to find correspondence that requires additional attention," Doyle says. "Our solution is equipped to handle claim payments, as well as miscellaneous correspondence that is indexed so the provider can quickly identify and respond to those documents requiring immediate attention."
Providers can view such items through the portal and enter notes about actions taken on the specific documents. This is an optional service that improves performance. Other services available include:
- Patient Pay: This remittance process automates the collection of final patient balances and creates an electronic file for the automated posting of these receivables.
- Electronic Bill Payment: This remittance process enables patients to remit online or by phone. Providers can also use this service to initiate calls and collect balances owed by phone. An electronic file is created for the automated posting of these receivables.
The Healthcare Lockbox is scalable to work for organizations including medical groups, specialty care groups, hospitals, labs, urgent care centers, dental practices, and companies offering billing services.
Contact your Treasury Management Sales Officer to learn how your business can benefit from a more automated process for handling claim payments and patient pays.