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EDI Claims: Why Use EDI in Healthcare?

As the digital world continues to advance, we are privileged to use various software and technologies that make our jobs easier. Once such technology is electronic data integration (EDI). EDI allows for improved healthcare claims processing, including better security and efficiency for patients and healthcare providers.Patient and medical staff

Security

EDI allows for improved security and privacy measures for healthcare claims processing. The Health Insurance Portability and Accountability Act (HIPPA) of 1996 protects patient’s privacy and provides boundaries as to whom medical records can be released to. EDI minimizes the possibility of information over sharing when it comes to medical records and health care claims submissions.

For example, traditional information sharing through paper claims mailed through the postal system or information emailed to an individual increased the chances that more individuals than necessary came into contact with the private information. While these individuals may have clearance to handle this information, it is an inefficient and insecure method of information sharing.

EDI, on the other hand, specifically integrates with a health management system within your healthcare practice to minimize information handling and claims processing. Instead of passing patient information from person to person (or email to email), the EDI software passes the documents through a securely integrated system that is based on specifically coded transactions.

These transactions can only be viewed and processed by another EDI system that can read the agreed upon standard formatting of these coded documents. This ability to share documents and information between EDI softwares that only accept certain codes increases the security of patient information and healthcare claims.

Efficiency

Efficiency is another great reason to use EDI in healthcare practices. EDI significantly decreases the amount of time it takes to submit and process a claim. Not only will most EDI’s help you to identify potential mistakes within the claim to be submitted, it will also assist in the processing by providing real time feedback about the claims submission.

Efficiency in processing allows for healthcare claims to be processed faster, meaning healthcare providers can get paid for services rendered more quickly through an EDI software.

Though security and efficiency are important aspects to any software within a healthcare practice, it is critically important within an EDI. For more information about plans and pricing of Apex EDI software, reach out to us on our Contact Us page. Security and efficiency are of utmost importance to our professionals at Apex EDI. We will be happy to assist you in incorporating a secure and efficient medical claims software into your practice.

http://www.edibasics.com/what-is-edi/
http://www.edibasics.com/edi-resources/document-standards/hipaa/

Articles with this disclaimer may not represent the beliefs or core values of Apex EDI. The following is simply a summary taken from the industry’s general community to help readers stay up-to-date on what people are talking about. 


Posted in: EDI Claims

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2016 Healthcare Claims Processing

Medicare Regulations Are Changing Come 2016. Apex EDI’s OneTouch® Healthcare Claims Processing Service Makes Change Easy

With the advent of 2016 just around the corner, we’re sure many of you are already aware of the coming Medicare Physician Fee Schedule (MPFS) regulation update this January. If not, here’s a quick look at just a few of the policies that will be affected by the new 2016 payment rules:

    Home Health Value-Based Purchasing

    Driven by mandates in the Affordable Care Act, Value-Based Purchasing incentivizes providers to increase the quality of their care. In fact, the amount of incentives participating agencies receive is directly proportional to the quality scores they earn. The program has been piloted through various disciplines within the medical industry, and beginning January 1, all Medicare-certified home health agencies operating in Massachusetts, Maryland, North Carolina, Florida, Washington, Arizona, Iowa, Nebraska, and Tennessee will move to a Value- Based model.

    The “Two-Midnight” Rule

    After considerable debate, the controversial “Two-Midnight” Rule CMS first introduced in 2013 will officially go into effect. In essence the rule clarifies that in terms of Medicare payments auditors must assume a hospital stay was legitimate and necessary as long as the stay spanned two midnights. (Stays under the two-midnight mandate will now be billed as outpatient observation care; a key difference in terms of healthcare claims processing.) According to CMS, this illustrates the “long-standing emphasis on the importance of a physician’s medical judgment in meeting the needs of Medicare beneficiaries.”

    End-Stage Renal Disease Quality Incentive Program

    Like the Value-Based Purchasing initiative discussed above, the new End-Stage Renal Disease rule will tie the incentives dialysis facilities receive to the quality of the dialysis care their patients actually receive. Quality of care will be determined with respect to measures such as infection rates, safety violations and overall patient experience. In fact, facilities that fail to meet a “total minimum performance” requirement will be penalized with a reduction in their rates.

    New Physician Payment System

    This change is garnering attention because it’s the first final rule issued since the sustainable growth rate formula was repealed by the by the Medicare Access and CHIP Reauthorization Act of 2015. The new rule covers quite a bit of ground, but most notably, also begins a new period of physicians and practitioners being paid according to merit. Like many other agencies, physicians will receive payment incentives for providing high-quality, while those who fail to meet standards may be subject to payment reductions. Also included is the institution of two new, separate billing codes for advance care planning services provided to Medicare beneficiaries. Formerly all advanced care planning has been coded under a single “Welcome to Medicare” visit. This change allows for Medicare coverage of more in-depth discussions.

While regulation change can seem confusing, rest assured that with Apex EDI’s OneTouch® electronic healthcare claims processing, we’ve done the heavy lifting. In all the ways possible, our real-time eligibility verification, patient statements delivery, and electronic remittance advice (ERA) will take regulation changes into account— ensuring that the process for collecting payments come January 1 is as simple and secure as always.

For more information on the 2016 regulation changes visit https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2015-Fact-sheets-items/2015-10-30-2.html.

Posted in: Healthcare Claims

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