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Practice Management Alert

Payer Updates:

One Payer Questions Cost-Benefit of EMR Systems

Published on Wed Apr 16, 2008

And in denial news, TrailBlazer shares a top-10 list to avoid

Some practices have been saying it all along: While electronic medical records (EMR) may improve information flow and patient care, they may not be cost-effective for physicians. One payer now officially agrees.

BlueCross BlueShield of Massachusetts recently announced that it will not require physicians to implement EMR in order to participate in its pay-for-performance bonus program. The payer reached its decision based on research of available studies including an American Medical Association study that estimated that doctors see only 11 cents of every dollar saved through health IT use.

In other news:

You may be able to slow your denial volume by simply checking your claim status. TrailBlazer Health Enterprises, the Part B carrier for Delaware, Mary-land, Washington, D.C., Virginia, Texas and the Indian Health Service, has re-leased its top-10 billing errors for its most recent quarter -- and results show that duplicate billing is the number-one error across the board. TrailBlazer denied more than a million claims for this reason alone in the fourth quarter.

Other common errors included beneficiary ineligibility, medical-necessity issues, bundled services, noncovered services, missing/invalid group number, provider ineligibility, and failure to submit the claim to the primary insurer.

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