RUN THE GAUNTLET: OUR EDI SURVEY CHALLENGE
1. Call Wait Times: — How long do I have to wait to speak with someone in support?
2. Payer List w/ Direct Connections: — Do you have direct connectivity to the payers I need to send claims to? (Direct payer connectivity mean less reliance on other clearinghouses, less future problems, and higher customer satisfaction.)
3. Knowledgeable Support: — How knowledgeable is your staff regarding payer rules, claims errors, and Practice Management (PM) Systems?
4. Patient Payments: — How well does your service help me estimate patient responsibility to determine the patient portion in advance so that our Front Office staff can collect patient payments at the time of appointment.
5. PM Interface: — Does your EDI system integrate tightly with my Practice Management (PM) System (or vice-versa) so that eligibility can be checked automatically from our patient scheduler? Is your support staff knowledgeable enough about my PM to assist me in using your EDI system.
6. Claim Scrubbing & Validation: — What are your rejection rates? To high, means too many payer denials. Too low means too many claim rejections at the clearinghouse level –in our experience +-3% is just about right.
7. Missing Claims: — My payer does not show as having received my claims. I don’t want to wait 2-3 weeks to find this out. How do I tell in minutes if I have missing claims on your system?
8. Claim Dashboard: — How well does your service help me manage unattended claims, rejections, and denials. Does it report back errors merely as numeric codes or as understandable explanations. Does your service report back to my PM with error messages, with ERA’s, with alerts on slow payments and potential cash-flow issues, such as excessive unpaid claim days?
9. Real Time RCM Reporting — Revenue Cycle Management (RCM): — How long do I have to wait to detect blocked cash-flow, or lost or unattended claims? Do you offer Proactive Revenue Controls? How well does your system proactively/continuously monitor key performance indicators (KPIs) that enable us to act in real-time to address revenue leakage before it significantly impacts our cash-flow?
10. Productivity Analytics : — How well does your service and technology give us insight into financial and operational performance across our organization against similar provider benchmarks?
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