Your orthopaedic practice faces an ever-changing landscape of policies and mandates that can force you to adapt your processes for revenue management. The recent 5010 transition and upcoming ICD-10 requirements, declining Medicare reimbursements, and growing patient responsibility for payments are just a few of the issues you face. Your practice needs systems and support you can count on to manage your revenue cycle more efficiently.

One of the most time-consuming and costly billing activities is identifying claims that were denied due to errors. In fact, medical practices spend as much as 14 percent of the insurance payments they receive in identifying, correcting, and collecting denied payments.

To help you control costs, submit clean claims faster, and get paid faster, the American Association of Orthopaedic Surgeons (AAOS) offers the Revenue Management Program powered by Gateway EDI. Gateway EDI is a claims clearinghouse that provides you, as an AAOS member, with discounted rates on its services. Gateway EDI’s service has helped thousands of practices reach 99 percent error-free claims. Reaching this level of clean claims significantly reduces turnaround time on reimbursement, as well as the time and costs associated with refiling claims.

“For our entire history, we’ve supported orthopaedic practices and their practice management software vendors. Now, we’re taking our knowledge of this specialty area’s unique claims processing challenges and combining it with special discounted rates for AAOS members,” said Jerry Winkelmann, the dedicated Gateway EDI account representative for AAOS members.

For cleaner claims

For any practice looking to submit cleaner claims, Mr. Winkelmann recommends taking the following 10 steps:

1. Identify one staff member to review all insurance payments for accuracy.
2. Review explanations of benefits (EOBs) and electronic remittance advice (ERAs) to address delays, denials, and reductions.
3. Analyze the reason and remark codes on payment adjustments, so you can address them quickly.
4. Verify patient insurance eligibility prior to each visit to ensure accurate claims.
5. Keep copies of contracted fee schedules and health insurer contracts, or store them in your practice management system.
6. Create a plan to upgrade your electronic transactions to meet the proposed ICD-10 compliance deadline of October 1, 2014.
7. Meet with your claims processing team regularly to evaluate your workflow for ways to improve efficiency.
8. Balance claim statistics to create a snapshot of how your office is performing.
9. Run staff productivity reports to see how your staff is performing over time.
10. Compare your office performance to industry benchmarks.

Is it time to switch?
In addition to taking these steps, it may be time to evaluate your current clearinghouse service.

Last September, Idaho Sports Medicine Institute made the switch to Gateway EDI. Billing Manager Cherie Salisbury said the four-physician institute has already seen some significant improvements over their previous clearinghouse.

“Before working with Gateway EDI, we didn’t know if a claim was accepted or denied until 30 days later when we received a paper notification in the mail,” said Ms. Salisbury. “Now, within 3 to 5 days of submission, Gateway EDI automatically informs us if a claim was denied and explains how to fix it in easy-to-understand terms. Being able to easily identify claims issues and fix them early in the process saves time, which also saves money.”

Gateway EDI’s direct relationships with more than 2,700 payers has also helped simplify administrative efforts at Idaho Sports Medicine.

“Gateway EDI has more direct electronic connections with insurance carriers than our previous clearinghouse. And, if they see that we’re submitting a lot of paper claims to a particular payer, they’ll proactively work with the payer to get us set up with electronic submission,” said Ms. Salisbury.

As for any practice, the switch to a new clearinghouse can seem daunting, but Gateway EDI helped ensure a smooth transition for Idaho Sports Medicine Institute.

“When we changed clearinghouses, Gateway EDI made the transition process easy by managing the payer enrollment paper work for us,” said Ms. Salisbury. “It can be a huge amount of work, but they did most of the legwork for us and made sure it was done right the first time. So, we were quickly up and running on submitting claims.”

“Getting reimbursed appropriately and in a timely manner is necessary to ensure a practice’s longevity. However, providers have so many other responsibilities they need to focus their attention on in order to serve their patients and support other business aspects of their work. As Idaho Sports Medicine can attest, with Gateway EDI’s help, the revenue side of a practice can run smoother,” said Thomas Grogan, MD, chair of the AAOS Practice Management Committee.

To find out more about special discounts for AAOS members or to sign up to receive other tips on how to get paid faster and a demo of Gateway EDI’s tools, visit www.gatewayedi.com/aaos

Jackie Ryan is manager, practice management affairs, for the AAOS practice management group. She can be reached at ryan@aaos.org