Dave Petsch has been in the respiratory services business for years, but he’s a newcomer to two-way electronic communication with health plans. Based in Martinez, GA, Petsch Respiratory Services historically has submitted its claims—up to 200 a day—to health plans through an intermediary clearinghouse. The front end is electronic, but the payments and the accompanying explanation of benefits were returned in the mail. Now, thanks to a technology push from state and federal health payers, Petsch is starting to see the electronic loop begin to close.
Last September, Petsch signed up for free electronic funds transfer/electronic remittance advice software offered by two of the three state Medicaid plans. Using software from Payformance Health, the two payers enable Petsch’s staff to log on to their secure Web sites and see a summary of all transactions. The payers send an e-mail notifying the durable medical equipment provider when new transactions are available. Any payments go directly into the Petsch Respiratory’s bank account. “We used to get payments 14 to 21 days after submitting a claim,” Petsch says. “Now it takes about five days.”
Petsch has a similar setup with Medicare and with customers on the federal employee health benefit plan. His14-employee business provides oxygen, wheelchairs and beds to some 3,000 patients annually. The EFT/ERA technology is a time-saver for office staff—and it decreases billing errors, Petsch says. “We have less data to enter,” he says. “It is easy to transpose numbers when you are recording 100 checks a day.”
Petsch’s crew downloads the transaction information into their practice management system. Together, the two Medicaid plans, Medicare and the federal employee plan account for about half the business of Petsch Respiratory. Now that the government-backed plans are on board with the technology, Petsch hopes that commercial health plans will follow suit. For good reason too—his business deals with more than 70 health plans.
Meanwhile, Petsch’s crew is grateful for whatever electronic efficiency they can get. Since adopting the EFT/ERA software, his six billing staff members spend less time adjudicating accounts. The durable medical equipment provider is trying to figure out how to bypass the claims clearinghouse, which exacts a transaction fee. The two Medicaid plans and Amerigroup enable direct submission of claims through their portals. That’s an option Petsch Respiratory is now considering. —Gary Baldwin