Hi Everyone -
I am in need of some guidance! I just recently started working at a practice and they are set to go live with a practice management system in about 3 weeks. Since I came from a practice already up and running on this type of system they have put me in charge of finding out how the EDI works and how to get that set up. They also want me to find out what each of the payers want in the ailment. I am at a loss because I only worked the front desk at my old practice and filled in for the girl in the billing dept on a very limited basis. I have explained this to my employer but this has still been handed over to me. Any advice of where to even start this process would be greatly appreciated! Thank you
Originally Posted by jessbrwn86
Do you have a background in IT? Because that would certainly help. I'm assuming you guys are already utilizing EDI for electronic claims - You could start by contacting your clearinghouse (Ours is Emdeon, for example), or the EHR vendor and finding out if they're compatable with each other, and see if they have tech support available to walk you through the setup. (Actually, I'd probably start with the EHR vendor - I'm betting they'd be more help.) Your electronic clearinghouse should know the requirements for each of your payers as far as what's required on the claims - if not, you're going to have to do the legwork and find out exactly what everyone requires. We have several different electronic claim formats; one for Medicare, one for Medicaid, one for BCBS, one for Firstcare, and one for all other Commercial payers - the differences are in the nuances that each payer wants (for example, Firstcare has a specific provider # that they want in box 24J, and so does BCBS; Medicaid may want the taxonomy code, Medicare may want the PTAN - everybody's different). You'll have to have your billing system set up to accomodate all of those differences.
Another thing to keep in mind with trying to convert EHR-->EDI is that EHR doesn't always code correctly (if ever). It doesn't always know which modifiers to use, and when, so I wouldn't advise a setup that automatically bills charges entered through EHR without manual (human) verification. You could end up with a lot of rejected and denied claims, if you're not careful.
And finally, you'll have to test the system to make sure everything's working. Seriously - call your EHR vendor and tell them about your struggle, and I'm confident that they will be able to help you. If not, then the doctor might want to consider going with another company. Hope that helps!
The only background I have is using the system at my old office maybe 3 times! Thank you so much for your help, I have been stressing out because I had no idea where to even begin!
I would have to agree with btadlock1. I have been working at a hospital for almost five years in their medical records department and we went "live" with EHR about 5 years ago. Our vendor is 3M and let me tell you, it was not an easy task. You definitely need IT people to work with the vendor, because there can be many technical computer issues that have to be worked out.
I am not sure what smaller practices are doing, but whoever is put in charge of going live with EHR's, they definitely need to know what they are doing. Where I worked we had our department manager, operations manager, coding manager, the IT people with the hospital and reps from 3M all working together to get the system going. Good luck!