How do EHRs specifically support insurance-based practices?
Electronic health records (EHRs) enable the independent physician to manage the patient’s care in a higher quality manner and provide a communication tool for patients and providers to engage with each other for improved patient outcomes. Beyond that, how do EHRs specifically support insurance-based practices?
In a recent national survey of physicians who use EHRs that are ready for meaningful use, it was revealed that:
- 94% of providers report that their EHR makes records readily available at point of care.
- 88% report that their EHR produces clinical benefits for the practice.
- 75% of providers report that their EHR allows them to deliver better patient care.
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In regard to EHR insurance benefits for independent practices, other reports show that EHR-enabled healthcare practices realize:
- Improved medical practice management through integrated scheduling systems that link appointments directly to progress notes, automate coding, and managed claims
- Time savings with easier centralized chart management, condition-specific queries, and other shortcuts
- Enhanced communication with other clinicians, labs, and health plans through:
- Easy access to patient information from anywhere
- Tracking electronic messages to staff, other clinicians, hospitals, labs, etc.
- Automated formulary checks by health plans
- Order and receipt of lab tests and diagnostic images
- Links to public health systems such as registries and communicable disease databases
- Reduction in charge lag days and vendor/insurance denials associated with late filing
- Charge review edits alerting physicians if a test can be performed only at a certain frequency
- Alerts that prompt providers to obtain Advance Beneficiary Notice, minimizing claim denials and lost charges related to Medicare procedures performed without Advance Beneficiary Notice.
EHRs also support insurance-based practices and their patients by giving the clinical staff the ability to validate the patient’s health insurance coverage, which optimizes the continuity of care provided by the physician. Recent research offered validation for taking advantage of the EHR insurance information as a way to help patients understand their coverage, including when it needs to be renewed, and as a tool for the practice to verify coverage for visits and procedures.
That research included analyzing correspondence between EHR coverage data, reimbursement data, and Medicaid data on insurance coverage for children’s primary care visits. EHR coverage data had high agreement with the two other datasets. The research findings suggest that EHR insurance coverage data is at least equal to Medicaid data in identifying insurance information for patients and may even be more accurate.
Data accuracy is critical for an insurance-based practice, to ensure proper and prompt reimbursement. The goal is to prevent denials and claim rejections and to improve the acceptance and payment rate for services provided by the independent practice for each patient covered by a third-party payer. EHRs support the insurance-based practice by helping to promote legible, accurate, and complete documentation for streamlined coding and billing, which improves the practice’s overall revenue stream.
