Is EDI Software a Necessity?

How Does Medical EDI Software Help?

Submitting claims electronically of necessity involved clearinghouse, switching, routing or hub services. It is here where automated data verification, rules checkers, validation control are employed to check each claim against a myriad of “rules” and quickly get that claim to the right medical aid destination.

On the return side Electronic Remit Posting or ERA will record payments with precision and in only a fraction of the time it would take to do the same task manually. Electronic Funds Transfer (EFT) esnures that the payment for services rendered get the money into the bank of the service provider 7-10 days earlier than when paper cheques are used. EFT takes human intervention out of the equation.

Not quite sure how electronic claim submission directly benefits your practice? Consider the following:

Studies have shown it takes about five minutes to formulate a medical bill manually and less than 30 seconds to make up very same claim electronically, and that includes time allotted to verification. Similar statistics are available for data conversions, database interfaces and electronic claims submission. Take some time to do your own study. Then do the calculations. The results will be compelling. Even without accounting for manual errors, the cost savings will be obvious.

And with each passing year these comparisons become even more compelling. Why? Because billing formulation and submission rules are being added and made more and more complicated.

Medical aids are finding ever more ways to deny claims and are doing it electronically. The information required to maintain an average patient record is enormous compared to a few years ago. It will continue to grow, dramatically increasing the need for an electronic data conversion or an integrated interface whenever a amendmment to the system is added.

Other examples can be presented but the point is clear, automation in the moderm medical practice is an essential component for efficiency and profitability. The calculations are clear on this.

Today’s medical practice simply cannot keep up manually. More manual labour is being demanded of good staff every day and that trend will continue. Good employees want meaningful jobs, not mundane and mindless data entry work.

To intercept and fix manual errors are more costly today than it was last year, and you can bet will increase in cost next year again. Reducing manual and redundant data entry, in any form, is of paramount importance in the increasingly narrow margins facing the modern medical practice.

As for software vendors competing for health care providers’ business, they will have to embrace more connected technology with dissimilar and embrasive systems in an attempt to remain viable in the future.

Already in the US we are seeing an accelerating trend among some vendors to collaborate on moving vital data between their different systems. An alternative is to use an outside consultant to develop and implement data exchange among your particular systems. This can be very effective because it addresses your specific needs. While at the same time it can also be somewhat expensive.

All medical practices, with few exceptions, submit claims electronically while most continue to post remittances by hand. Fairly soon the future will mandate that these be handled within the medical practice management software itself.

With the computerized systems being the order of the day by all players in the health care field, the wisdom of capturing data once and moving it electronically from system to system is becoming an inevitable economic necessity.

If your practice management software software company does not offer a cost effective and accurate exchange of data in all their varied forms among dissimilar systems, then be on the look out for a company that does. Embracing data interchange is a “must have” in the practice management software vendor you choose.


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