Providers are usually well aware of the upfront cost of an EHR program, but fail to realize its real cost. Smaller providers are more likely to avoid using an EHR program because of the expense and complexity. For instance, a small chiropractic clinic may find it financially more feasible to pay the penalty for not using an EHR program, compared to actually implementing the program. What such providers don’t recognize is that not all EHR programs are cost prohibitive and there are actually some free ones available.
Medicare currently penalizes eligible professionals (EPs) who fail to demonstrate meaningful use with a penalty of 2% as of 2016, and this is slated to go up to 3% in 2017. This means that any EP who is not using an EHR program will receive reduced payment for services provided to a Medicare patient. EPs weigh the financial burden of paying the penalty against the cost of purchasing an EHR program and the associated costs of demonstrating meaningful use. In addition to cost, an investment of time is needed to put an EHR program into action.
There are some hidden costs associated with EHR programs that providers may not be aware of. The EHR vendor may indicate to a healthcare provider that billing is included in their program and there will be no need for a third-party billing service. Alternatively, some vendors may offer medical billing at an additional cost which is much higher than what dedicated billing companies charge. The difficulty is that even though the program features a claim scrubbing software to check for and eliminate errors, it cannot replace a human biller.
Billing software that is inbuilt into an EHR program may fail to correct something as fundamental as an invalid ID number. If a patient’s insurance information is not up-to-date, the clearinghouse will reject the claim, and this will then need human intervention to determine what went wrong.
What’s important to understand is that medical billers are not simply data entry operators; they are trained to analyze data. While automatic posting of ERAs saves considerable time, the information still needs to be checked to ensure that all services provided have been claimed for reimbursement. As an example, if an EKG is done during pre-operative clearance for knee replacement and billed as EKG for knee pain by the EHR software, it is likely to be rejected. However, a human biller will be able to verify that the EKG was done because the patient suffers from atrial fibrillation, which is what the primary diagnosis should have been instead of knee pain.
The upshot is that software is an excellent tool to save time in the billing process, but it cannot replace human intelligence. Even if the software can successfully submit 100% correct claims, there may be errors at the insurance carrier end, which will need to be evaluated by a human being for appeal, adjustment, and resubmission.