Jimmie,
Thsi is typicall how it works:
Step 1. The provider submits his billing to us (usually a superbill). The provider office either faxes to us, scans then uploads to us via SFTP, or we interface with his EMR.
Step 2. Our staff then fixes modifiers and so forth and then bills out the claim to the clearinghouse who then sends to the carriers.
Step 3. The auto posting program you saw is completely automated. There is no user interface. It downloads remit files from the clearinghouse's SFTP server and posts them automatically. Reports are available that show all transactions that went in with no problem, transactions that could not be posted and the reason why (e. g. bad date stamp, etc.), claims that have not been paid in x number of days, etc.
Step 4. Our staff reviews the bad transaction report and posts those transactions manually.
In regards to capturing correct billing data, no matter how you slice it and dice it correct billing comes down to the provider. If the provider forgets to enter a diag code into the EMR or circle a diag code on the paper superbill, sooner or later someone has to come back behind him and clean it up. We work with our providers to explain this and help them. And our staff has years of experience fixing bad claims.
The auto payment posting program's job is to save labor. Like the sentence at the bottom says, we would have to hire way more employees to post that many transactions manually. Instead, we are able to pass cost savings over to our clients in the form of lower percentage rates and "freebie" work.
JamesNT
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