For anyone still questioning the value of medical billing software that integrates electronic clearinghouse transactions, a new study by the Council for Affordable Quality Healthcare (CAQH), a nonprofit alliance of health plans and trade associations, has quantified the savings from electronic transactions.

The 2013 U.S. Healthcare Efficiency Index, which tracked data from health care transactions for 100 million patients and over one billion claims, shows the savings from electronic claims processing and the potential for future reductions in costs in multiple areas including electronic medical eligibility verification, electronic funds transfer and electronic remittance advice. The study also noted an estimated 91 percent adoption rate for electronic claim submission, the highest level of electronic adoption of all transactions studied.

Savings Opportunities Now and in Future

The index showed that continued migration to electronic processes for health care administrative transactions presents an opportunity to greatly reduce costs (see chart below for detail):

  • Electronic medical eligibility and benefit verification could save health plans and healthcare providers $3 each per transaction, presenting the greatest opportunity to eliminate costs permanently.
  • Providers also have an opportunity to realize significant cost savings by migrating from manual to electronic transactions for prior authorization and referral certification, a potential savings of $13 per transaction for this heavily labor-intensive process.

Healthcare providers have been relatively slow to adopt electronic funds transfer (EFT), according to the study, with over 40 percent of claim payments still made by paper checks. In addition, electronic claim remittance advice and posting and receiving of payments showed the lowest level of adoption in the study at 53 percent, with more than 10 percent being transmitted both electronically and via paper. The CAQH study pointed out that this is a high-value opportunity to eliminate redundancies.

However, the trend toward electronic funds transfer (EFT) is gaining momentum in healthcare, according to a recent report by NACHA, the Electronic Payments Association. In June 2014, more than 11 million healthcare EFTs were made, compared to just over 8 million transactions in January 2014, the first month in which health plans were required to be compliant with the healthcare EFT standard transaction.

Medical billing software and EFTs

Make sure your practice is seeing the full benefits of medical billing software and electronic claims processing with a fully integrated EHR, medical billing software and clearinghouse. Using an integrated package eliminates fingerpointing between vendors and reduces time to receipt of payment.

In addition, billing software with an integrated clearinghouse blurs the artificial lines between each function that have existed in most products for years. For example: When reviewing a claims work list, the user must be able to see all payer rejections processed via the integrated clearinghouse on the same interface as their appealed claims that are derived from the billing system. Without seamless integration, workflows can never be optimized and inevitably certain claims will get “lost”.

As one of our users, podiatrist Dr. Peter Brieloff, said about MediTouch’s fully integrated software, “It’s so fast. I get my Medicare remits in 14 days; before MediTouch it could be as long as 21 days.”

That’s the difference of a fully integrated EHR, medical billing software and claims clearinghouse. Let us show you how it will help your practice.

Study of medical billing software electronic transaction savings