May 2006 Newsletter
Accelerated Secondary Claim Processing
In the Healthcare Business Office, every day counts, so a process promising to accelerate reimbursement is certainly attractive. Prompt payment of clean primary claims, especially to Medicare, is fairly well assured in this day of electronic claims adhering to transaction and code set standards. Claims to payers secondary to Medicare, however, are often blamed for sending that “Days in A/R” number climbing.
To solve this problem, Directors and Managers have traditionally looked for options for speeding up the submission of secondary claims, using software and processes specific to this task. Generally speaking, that has meant querying the Medicare Common Working File (CWF) two to four days after submission of a primary claim to Medicare, and extracting those elements required to create the claim to the secondary payer and the Explanation of Benefits (EOB) which must accompany it. The secondary payer can then be billed before payment from Medicare has actually been received.
The ASP Issue
Because the software involved in accelerating secondary claim payment represents a financial investment, there is wisdom in evaluating the expected return on that investment. To accurately assess the value of such Accelerated Secondary Processing, several factors must be taken into consideration: the trend toward automated crossovers and Coordination of Benefits, the number of Medicare claims with secondary payers, and the payment schedules of secondary payers.
Automatic crossovers, once limited to those claims with a Medicaid or Blue Cross program secondary, will eventually be standard for most secondary payers, reducing, if not eliminating, the need or opportunity for generation and submission of hardcopy claim and EOB forms. The ANSI standard adopted for electronic claim submission according to the provisions of HIPAA also contains the requirements for electronic transfer of claims from Medicare to other payers. To facilitate that transfer, the Coordination of Benefits Agreement (COBA) Program has established a nationally standard contract defining the criteria for transmitting enrollee eligibility data and Medicare adjudicated claim data. Parallel (beta) testing with ten COBA trading partners beginning in July 2004 allowed for the identification and correction of several issues; standard testing for trading partners is now underway.
Evaluating ASP Need
Because the process of Accelerated Secondary Processing is potentially costly and time-consuming, it is worthwhile to evaluate how many Medicare claims do record a secondary payer, what individual co-pays may be, and what amounts may apply to deductibles. A decision to accelerate the billing process may be warranted if any of those volumes are significant. Should such an evaluation reveal, however, that the number of Medicare claims qualifying for additional reimbursement is small, it may not prove cost-effective to implement an Accelerated program.
Payment schedules of secondary payers are likewise worthy of evaluation. Does a payer have a semi-monthly payment schedule, which may mean that, regardless of how quickly the claim gets to them, it may be scheduled for payment two weeks out? If a secondary payer generates payments on the 15th and 30th of the month, for example, it may not be prudent to make the investment to accelerate secondary claim creation on the 16th or 1st of a month. Unless the timing is perfect, hurrying a claim to a payer with a semi-monthly payment schedule will not result in any faster reimbursement than if the claim were submitted using the normal remittance process. Furthermore, some payers have determined that a claim secondary to Medicare may be held for 30 days before releasing payment and still meet legislative timely filing guidelines.
ASP Solutions
Weighing these factors, along with our desire to satisfy client interest in an accelerated capability, against the cost of investing in the development of a proprietary system has resulted in our decision to partner with Emdeon (formerly WebMD). Emdeon Medicare Secondary Billing – Accelerated (formerly Accel) offers these and other features and benefits:
- Performs immediate claim status inquiries against the Medicare online system (CWF)
- Offers flexible data retrieval and reporting capabilities
- Allows providers to bill secondary claims 10 to 12 days before payment is received on the primary claims
- Collates and prints secondary claims and EOBs using stock paper, rather than expensive UB92/CMS1500 forms
Those who remain “on the fence” with regard to the concept of accelerated processing may find that our Automatic Secondary Payer functionality, coupled with the increasing number of payers that are accepting Coordination of Benefit (COB) claims electronically, provides a complementary cash flow alternative.
Your EDI Support Representative would be happy to review all options for secondary billing with you; please feel free to phone the EDI Client Support Center at (866) 422-8079 or log an event to the Help Desk through the Quadax ASP Portal to ask for a consultation.