What Is Electronic Remittance Advice (ERA) In Medical Billing

Electronic Remittance Advice (ERA) in Healthcare Billing

In the world of healthcare billing, accuracy and communication unfortunately don’t always go hand-in-hand.  Electronic remittance advice (ERA) is an effective way of streamlining the communication between medical providers and insurance coverage providers to ensure data is transparent and accurate. In this blog, we’ll dive into ERA in medical billing and why it is so important.

What is an Electronic Remittance Advice (ERA)?

What is an ERA? An Electronic Remittance Advice (ERA) is a digital resource that cuts out the paperwork to increase efficiency in the traditional process known as Explanation of Benefits (EOB) Statements. ERA medical documentation, even though it is digital, is critically important in the management of healthcare practice financials. ERAs are sent from payers to healthcare organizations, and include details around claim denials, claim status, or any changes the payer made to the billed amount.

Having a comprehensive and well-designed ERA process helps to improve communication and comprehension of a patient's health care coverage, payments, and denials from the insurance payer.

What Does EFT Stand For?

Electronic funds transfer (EFT) is the process of transferring funds over electronic or digital methods. It's a critical component in managing healthcare payments from insurance payers to healthcare providers. The benefit of EFT is that it eliminates any type of physical check that could get lost in the mail, while also directly improving the overall speed of payments. Payment transfers conducted through ETF tend to be safer, faster, and even automated in some billing processes, ensuring they are made readily without the risk of human error. 

The Importance of ERA in Streamlining Payments

ERA in medical billing is a pivotal component of the payment processes in place within healthcare organizations. ERA healthcare claims and payments are significantly faster and more efficient when managed electronically. There are other benefits as well, including:

• Reduction in errors due to automated processes
• Reduced need for manual data entry, saving employees' time
• Expediting account reconciliation

Benefits and Advantages of ERAs and EFTs

ERA in Medical Billing: Benefits and Advantages

The advantages of implementing ERA in medical billing, while specific to the organization, typically include the following:

• Error reduction
• Automated payment posting
• Improved financial management accuracy

ERA tools help provide data that can analyze all aspects of the organization's finances, including claim payments and denials, identifying payment trends, and optimizing opportunities for improving revenue cycle management. Ultimately, implementing ERA in medical billing can increase cash flow and bolster financial stability within the organization.

EFT in Medical Billing: Benefits and Advantages

Implementing ERAs can bring a range of benefits to the organization, and these are only enhanced when EFTs are also included in the process. By combining EFT and ERA, organizations see a significant improvement in efficiency throughout the billing process. The elimination of physical checks directly improves speed, supporting more efficient cash flow management. It also enhances security, minimizing the risk of lost or stolen checks and creating a simplified but effective audit trail. Ultimately, the investment in ERA billing, along with EFT, improves the entire process, streamlining billing, increasing efficiency, and improving security.

Understanding the Components of an ERA

ERA healthcare applications can be rather complex, or at least, they seem so initially. Understanding the process can eliminate risk, so a period of training and education is essential. Organizations that implement and train employees on the use of ERA will achieve ultimate cost-saving and time-saving benefits. However, to do this, it's critical to fully understand how ERA is structured. The main components of an ERA are typically as follows:

• Header information: This area includes EFT numbers, payer tax information, total payment amount, payment method and data, as well as payer identification.
• Claim details: The next section offers more details, including the claim and account number, the current claim status, submitted claims, payments, and patient identification information. It also includes any details as they change over time due to the approval or denial of claims.
• Payment specifics: This component will list the payment details, including where the account stands.
• Remark codes: The final section allows for any detailed notes and insights necessary

How ERA Improves Revenue in Healthcare Organizations

The implementation of ERA into a healthcare organization's revenue cycle provides numerous benefits. The most important is automated payment posting, which eliminates the risk of errors. This also allows for better oversight and solutions when discrepancies are discovered. Organizations can use the valuable data provided by these tools to not just meet the patient's needs, but to look for insights that can improve overall outcomes. Ultimately, when used properly, it can help to improve the claim submission process and maximize the reimbursements that healthcare organizations see.

ERA in Healthcare: Common Challenges and Solutions

Like any new system or process, there are likely to be some challenges when implementing ERA. This is typically a result of the learning curve. For example, a lack of standardization of processes and procedures can lead to complications down the road. Another concern occurs within organizations that use multiple software products. If these tools cannot integrate, this can lead to higher costs more time consuming processes.

Many organizations worry about data security and privacy standards . While ERA does create new ways to share information, if implemented properly it can minimize the risk of HIPAA violations or other compliance risks.

ERA software can be versatile, and when properly evaluated, selected, adopted, and used by employees, it can improve workflow integration and help to provide remarkable improvements in data security. This enables efficient and secure ERA processing.

Implementing ERAs and EFTs

Implementing ERA in Your Medical Billing System

Integrating ERA into your medical billing systems can be done rather efficiently once an organization selects the ERA software they wish to use. Teams can take the following steps to implement ERA:

• Evaluate the current methods to determine any integration limits or concerns
• Select appropriate software to meet the organization's needs and tackle current challenges
• Train staff on the use of the platform
• Establish key performance indicators and begin monitoring them
• Work towards improving any gaps that exist in timelines and efficiencies

With the potential to offer seamless integration, ERA can begin to work on creating efficient billing strategies and optimizing revenue nearly immediately.

Implementing EFT into your Medical Billing System

To implement EFT into the medical billing system, there are several steps that organizations need to take.

• Obtain necessary authorizations
• Set up a dedicated bank account to handle transactions
• Ensure smooth integration with billing software
• Incorporate staff training
• Test systems to ensure the process works as expected

ERA vs Traditional Paper-Based Billing

When making the decision to move towards ERA healthcare systems, organizations need to consider the differences this will create within operations, especially if they are currently using paper-based billing. These teams will see a reduction in administrative costs as they will no longer need to collect or update paper checks.

There's also the benefit of significantly fewer errors and payment reconciliation that is streamlined, efficient, and faster overall. This allows organizations to instantly gain information about payments, find errors faster, and create resolutions sooner. Compared to paper billing, it's far more efficient.

Choosing the Right ERA Software

Before investing in ERA technology, organizations should consider:

• Compatibility with existing billing systems and processes
• Support for any payer formats currently used
• User-friendly design
• Data security levels and risk
• Vendor support

Not all products are the same, and finding the best solution for your practice can make the world of a difference.

Summary

An Electronic Remittance Advice (ERA) is a digital asset that is shared from payer to provider that includes information on whether a claim is paid or denied, the claim's final status, and any changes made to the billed amount.

An EFT is an Electronic Funds Transfer, is the processes used to digitally transition a payment from a payer to a provider.

By taking a digital-first approach, ERAs and EFTs can create game-changing efficiencies for healthcare organizations, saving time, costs, and reducing errors.