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There is so much hype out there about electronic medical claims billing. If you are not sending your claims electronically yet, you are probably too embarrassed to admit it. And if you are, you are probably wondering if the method you are using is the best. What is the real truth behind electronic billing?

Many of the larger insurance companies are really pushing providers to submit their claims electronically. Some are even calling the provider’s offices and telling them that they are mandating electronic submissions by a certain date and that they will no longer accept paper claims. Others offer incentives to submit electronically, such as faster payment, or even no authorization required for services if claims are submitted electronically.

Bottom line, the real question for a provider is “is electronic billing really necessary for my practice” and “what will it require of me.”

For the first question, I think that everyone must realize that with the changes in technology electronic submission of medical claims is inevitable. Today’s society is moving towards paperless transactions in many ways.

The second question will depend upon many things such as how large, or small, your office is, how much equipment you already have and how up-to-date it is.

One of the biggest misconceptions of electronic billing is that it makes the billing in your office a lot simpler. In some ways it does, but it presents you with a whole different set of tasks that you didn’t have before. I’m not implying that it makes anything harder. Just that there are things that go along with electronic billing that you did not have to do before such as reading and acting on reports and maintaining and updating the electronic software.

When you submit a claim on paper, the claim is both received and processed, or you never hear a thing. Hopefully in the latter case, your staff will call and check status on it after 30 days. Whether your paper claim has complete and accurate information on it or not, it will be handled the same way. You will either receive payment for the claim, or an explanation of benefits showing a reason for denial.

When you submit claims electronically, it is not quite so simple. First, you will receive a report letting you know if your batch of electronic claims was accepted or rejected. If a claim has incorrect data such as an incorrect date of birth, it will be rejected before it ever reaches the insurance companies claims processing system. You will receive a report, usually within 24 - 48 hours showing all rejected claims, and the reasons for the rejections. You will also receive a report showing the claims that were accepted with no errors.

It is very helpful to receive notice so quickly that your claim had incorrect information; however, you now have to make sure your staff is able to check on this report and take the time to find and correct the needed information.

What electronic billing is actually doing is letting you know sooner that you have problems with specific claims. When you are submitting them on paper, you generally don’t find out about the problem claims until you are doing a follow-up report and calling the insurance companies. So by submitting your claims electronically, you are not eliminating all the problem claims, you are finding out about them sooner.

Once you decide to take the plunge into electronic billing, there are still choices to be made. Is the practice management system you are currently using capable of submitting claims electronically? If not, you will need to update or change your software. You will need to determine how you will submit your claims to the insurance companies. A clearing house may be the best option, or if you are a larger practice, or billing service, you may want to consider software that allows you to act as your own clearing house.

In any case, if you are not already submitting your claims electronically, it probably would be wise to start researching your options. A good place to start is by contacting your practice management system support and asking them if they recommend any method in particular. Another way is to ask your colleagues. Electronic claims submission is a big step and it should not be taken lightly.

Copyright 2006 Michele Redmond

Michele Redmond is co-owner of Solutions Medical Billing and has been in business since 1994. She has a bachelor’s degree in Computer Information Science and is responsible for the electronic claims submissions for over 50 providers. For more information on clearing houses and other alternatives for electronic claims submissions visit her website at http://www.solutions-medical-billing.com

Microsoft Great Plains might be considered as ERP platform to build your own custom solution upon or as the assembly place for the existing modules. Microsoft Great Plains has Inventory Control (IV), Bill of Materials (BM), Manufacturing modules, coming from Microsoft Business Solutions directly, plus it has third party solutions, such as Horizon Light Manufacturing. In Food Processing industry, however the manufacturing itself is so-called process manufacturing, where with variable input you have variable output. It is opposite to discrete manufacturing, where you expect exact number of parts to be assembled into exact number of finished products. In our opinion - you should first understand your options to automate business processes and if Manufacturing module is absolute must - only then you should purchase manufacturing and implement it. Let’s give you some highlights:

• Variable Input Unit Weight. You still have to count input units, but in parallel with this you should use Pounds (US) or Kilograms (Europe, Australia, Canada). This means that Great Plains should give you catch weight routine. You can purchase simple catch weight module from existing Microsoft Great Plains partner and tune it, using Great Plains Dexterity, Modifier with VBA and SQL Server scripts. We saw the requirements when Food Processor has to control weight variations to prevent theft and issues like that. In this case you tract average weight of the input item. This is classical Dexterity routine. As this catch weight system becomes your light manufacturing application - you will need MRP reporting - use Crystal Reports to cover your reporting needs, our recommendation is to create SQL views and stored procedures for your Crystal Report

• Repetitive Customer Orders. If you are food processing company - you probably have fixed number of permanent customers - grocery stores, food retail chains, restaurants and each permanent client orders the same set of products on the regular basis. You should have so-called Order-Pad with historical customer typical order components, where you just verify quantities.

• EDI. In the case of large grocery stores you may need Electronic Document Interchange (EDI). The easiest way to create it in Great Plains - export SOP orders via EDI fixed-length-position SQL formatted query. You can have it as SQL routine to export Customer orders into text file and forward it to the customer through EDI channel.

• eOrder. Smaller customers (Restaurant, Specialty food outlet) are willing to place internet orders. In Microsoft Great Plains you could deploy eOrder to sell on existing account.

We encourage you to analyze your alternatives. You can always appeal to our help, give us a call: 1-866-528-0577 or 1-630-961-5918, help@albaspectrum.com

Andrew Karasev is Chief Technology Officer at Alba Spectrum Technologies (http://www.albaspectrum.com), serving Microsoft Great Plains, CRM, Navision to mid-size and large clients in California, Illinois, New York, Georgia, Florida, Texas, Arizona, Washington, Minnesota, Ohio, Michigan, UK, Canada, Brazil. Mexico

Microsoft Business Solutions Great Plains is marketed for mid-size companies as well as Navision (which has very good positions in Europe and emerging markets where it can be easily localized).

Great Plains Bank Reconciliation (BR) module lets you manage all of your bank-related activity through a single automated intersection, including cash, check, and credit card transactions, bank account balances, and automated reconciliation.

BR extends your reconciliation capabilities with ease using customizable transaction views, summaries of important information, historical balance inquiries, and easy-to-use tools to sort and mark transactions as you need. Empower your employees with a straightforward, consistent approach to managing your bank transactions that lowers administrative costs and gives you tight control over this mission-critical business process.

Features:

• Summary Information - Speed up reconciliations with on-screen summary information, including adjusted bank balance, adjusted book balance, number of cleared payments, cleared payments total, and more.

• Detailed Transaction Information - Instantly get the details you need while reconciling, including deposit number, transaction number, type, payment amount, and description, then drill down when you need even greater detail.

• Transaction Tracking- Track simple or complex transactions, including voided transactions, voided manual checks, funds transfers, deposits without receipts, and checks distributed to multiple expense accounts.

• “Point in Time” Balance Inquiry - Resolve discrepancies by viewing the bank transactions that make up your checkbook balance for a specified date and drill down to view the cleared status of the transaction.

• Automatic Adjustments - Reconcile totals with automatic file update and General Ledger postings that include reconciliation totals as well as any transaction adjustments.

• Simultaneous Reconciliations - Manage multiple reconciles out of separate checkbooks without having to complete each one before beginning the next.

• Reporting - Create, view, and post a suite of standard reports including checkbook list, checkbook register report, and bank distribution history, or customize reports in paper or online formats.

• Multicurrency Support - Enter, view, and reconcile transactions for checkbooks in any currency, or reconcile cash receipts in multiple currencies in your primary checkbook.

• Seamless Integration - Create complete bank-related information and enter information only once with seamless integration to Great Plains General Ledger, Receivables, Payables, and Payroll modules.

Good luck with implementation, customization and integration and if you have issues or concerns - we are here to help! If you want us to do the job - give us a call 1-630-961-5918 or 1-866-528-0577! help@albaspectrum.com

Vincent is a Great Plains specialist in Alba Spectrum Technologies (http://www.albaspectrum.com) - USA nationwide Great Plains, Microsoft CRM customization company, serving clients in Chicago, Houston, Atlanta, Phoenix, New York, Los Angeles, San Francisco, San Diego, Miami, New Orleans, Toronto, Montreal and having locations in multiple states and internationally.

When talking about workforce management software it is very important to see organizing as a multi-step process. It involves detailing all the work that must be done to attain the objectives. Secondly, you must understand the term differentiation, which is dividing the total workload into activities that can logically and comfortably be performed by one person or by group of persons. Then comes the important task of departmentation that involves grouping the related tasks in a logical manner.

The next step is setting up a mechanism to coordinate the work of members into a unified whole by establishing authority - responsibility relationships; this involves delegation and decentralization of authority. Last but not the least, workforce management software plays a pivotal part in monitoring the effectiveness of the organization and making adjustments to maintain or increase effectiveness.

The various steps stated above in organizing process results in a structure that facilitates the performance of tasks in a cohesive way. The resulting structure, however, is not a static form, like the structure of a building. Since structure is based on plans, major revision of plans may necessitate a corresponding modification of structure. As such, organizing and reorganizing in workforce management software are ongoing processes. Successful organizations continuously assess the appropriateness of their structure and change it in accordance with the dictates of the environment.

The managerial function organizing may be defined as defining and grouping the activities of the enterprise and establishing authority, responsibility and relationships among them. And that’s where the creation of structure takes place, a structure that is most appropriate for the organizations objectives and other internal and external factors. The best structure is the one that enables the organization to interact effectively with its environment, to efficiently channel the efforts of its people, to make efficient use of its resources. Thus, when planning specifies the objectives, organizing facilitates the accomplishment of objectives.

Workforce Management provides detailed information on Workforce Management, Workforce Management Software, Workforce Management Solutions, Workforce Management Systems and more. Workforce Management is affiliated with Workflow Management.