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Insurance Payments – Ask A Biller #4

In Ask A Biller Episode 5, Dylan and Maggie answer all of your questions about insurance payments and common acronyms: EOBs, ERAs, and EFTs. As always, you can check out the full transcript or download the slides below.

See the full transcript here (scroll to read):

MAGGIE: Hi and Welcome to Episode 5 of Ask A Biller, My name is Maggie, I’m an insurance specialist with SimplePractice

DYLAN: And I’m Dylan, your SmartBilling Pro expert. Today we’re going to be talking about how to decode the payment information that you receive from the insurance company.

MAGGIE: For today’s episode we will be focusing primarily on Explanation of Benefits, Electronic Remittance Advice, Wire transfers aka EFTs, and good old fashioned paper checks.

DYLAN: Remember, if you have questions that pertain to your SimplePractice account, our support team offers a plethora of classes, including an insurance billing class every tuesday at 11am pacific and thursday at 3pm pacific

MAGGIE: Cool. Let’s dive in. The first thing that we’re going to talk about is Explanation of Benefits, commonly abbreviated to E-O-B

DYLAN: When you’re an in-network provider, an explanation of benefits will be sent to both you and your client. It’s a document that provides a detailed breakdown of the services that were rendered and how the client’s benefits were applied to each session

MAGGIE: If you’re seeing multiple clients that are covered under the same payer, your EOB will likely include sessions for multiple clients over multiple dates of service. Every payer is a little different with how they format their EOBs, but you can expect the same general anatomy of an EOB each time

DYLAN: Double check that the following is listed correctly on the EOB

MAGGIE: Let’s take a closer look at this sample EOB in an effort to make sense of all of these words and numbers. Again, every EOB will look a little different. Today we’re looking at a copy of BCBS of North Carolina EOB

DYLAN: It’s important to thoroughly check every EOB for accuracy. The first field here is Your Provider Billed. This would also likely just say billed amount and it should match your full session fee.

MAGGIE: The next field is for the allowed amount. This is another term used for the contracted rate that you agree to receive for your services when you are paneled with a payer

DYLAN: And to your right of that we have the member savings field. This is more commonly referred to as a write-off or contractual adjustment, but member savings is a good way to think of it. This is the portion of your private session fee that you agree to deduct in order to be part of an insurance panel. It’s important that you keep track of this amount when you’re recording your insurance information so that you always know how your fee is being parceled out.

MAGGIE: The next field here is your plan paid– this will also be called total paid or payment to provider– this is how much you will have receive from the payer. On this EOB example, the allowed amount went towards the client’s deductible, so there’s no payment here

DYLAN: And next we have a break down of the client’s benefits by: copay, deductible, and coinsurance. These fields represent the money that your client owes to you or has already paid you.

MAGGIE: And last but certainly not least, you may see some reason codes on your EOB. These are there to explain why the payer is denying to reimburse you, or is only partially paying for the services. Somewhere on the EOB there should be a better definition of the reason code, but if not, there are plenty of resources on the web to turn to to decode a denial

DYLAN: Here are some of the common reason codes that you may see. These are medicare codes.

MAGGIE: Before automated claim filing became the widely accepted norm, the preferred method was mailing and faxing claims, and EOBs always came in the in the mail. These would serve as your first indicator that the payer received and processed your claim.

DYLAN: However, now since almost everything that keeps your practice up and running is online, so are your EOBs. And they aren’t called EOBs when they’re online, they’re called Electronic Remittance Advice– or more simply, an ERA

MAGGIE: You may also here this referred to as an 835 or in SimplePractice, a payment report. But don’t let these names fool you, this is the exact same thing as the EOB we just went over, but with a fancy name

DYLAN: This is an example of what your ERA may look like. Unfortunately not all ERAs and EOBs are as clear or easy to understand as the example that we went over above. That’s why SimplePractice offers a feature to automate the delivery of your ERAs right into your client’s account. We’ve asked Natasha, one of our very best and brightest product specialists to go over this feature for you

Hi there and welcome to Support Says– my name is Natasha and I’m a product specialist here. Today i want to tell you a little bit more about the automatic payment report feature that comes with your professional simplepractice account. This feature is designed to give you back all that time you’ve been spending tediously adding up your insurance payments

First things first, you’ll need to submit an enrollment and get approved by the payer to have your ERAs sent to our clearinghouse and ultimately into your SimplePractice account. This process can take about 8 weeks depending on how quickly the payer processes your request.

Next, proceed with filing your claims like you always do– check in periodically to see that your claim status is updating– and then one day, you’ll check into your claims and see that they’ve been updated to Paid

And along with that you’ll receive a payment report. You can view this by clicking Payment Overview right on your claim. This is a simplified breakdown of how this claim was processed– what the insurance pays you, what your client pays you, and what is written off

This information will automatically post to your client’s account so you don’t have to go through and add each payment. A few things to keep in mind with payment reports are:
Some payers don’t include the write off amount when they send the information over, so you may need to go in there and and calculate that amount yourself
When there’s a $0 payment from the insurance– like when the full allowed amount goes towards their deductible, you will have to go in there and fill out the write off amount
And last but not least, if you receive a payment for a claim that is not in SimplePractice– this will result in an unallocated payment amount
Once you start receiving payment reports, you can view them all in one place by going to Insights>Electronic Payment Reports

Thanks so much for joining me on this segment of Support Says!!

Back to Maggie and Dylan

MAGGIE: Thanks Natasha! So now that you have all of this information we can imagine the next questions on your mind is….so when do i actually get paid? And the answer to that question is… it depends

DYLAN: The reason it depends is because your payments will either come by mail or by electronic wire transfer. When they come in the mail they will come along with your EOB. In order to receive your payments via direct deposit, you’ll need to enroll for EFT also known as electronic wire transfer. Some payers require that you enroll for EFTs before you start receiving electronic payment reports

MAGGIE: A lot of customers ask– what is the average turnaround time to expect for claim payment and unfortunately that’s a question there is no right answer for. When you sign up for electronic payments and payment reports, you’re bound to get reimbursed faster than you would if you’re waiting for mailed checks, but ultimately, turnaround time is entirely dependent on the payer that you’re working with and can be anywhere from a week to up to 45 days

DYLAN: That’s all we have for today, thanks so much for tuning in. Join us on June 21st for a Live Q&A broadcast. Remember, you can get updates and see all the past episodes of “Ask a Biller” on our youtube channel, so make sure you subscribe!

MAGGIE: And remember, if you have questions that are specific to your SimplePractice account, take a look at our HelpCenter at support.simplepractice.com and browse through some of the live support classes that we offer by going. Until next time,

MAGGIE, DYLAN: Keep it Simple!

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