Physiatry Practice Management Resources

America's largest health insurer, Aetna U.S. Healthcare, is doing just that. As part of a larger initiative "to make it easier for physicians to do business with us," says Dr. John Kelly, director of physician relations, Aetna has made over 200 -- or about half -- of its coverage policy bulletins available on-line at its Website (www.aetnaushc.com). Aetna is also offering medical practices the option of electronic verification of member eligibility, as well as other electronic services, such as referrals.

Aetna's larger agenda involves using the Internet to alleviate a host of problems that plague physicians in their dealings not only with Aetna, but with other plans as well.

In addition to the issue of easy up-front access to information about which services are covered and whether a patient is eligible, there is the issue of prompt payment of claims.

So badly does Aetna want doctors to do business with them on-line that they are promising to pay within 15 days any "clean" claim that is electronically submitted. Dr. Kelly says that using E-pay, as the service is called, facilitates the submission of clean claims because "it eliminates the kinds of easy mistakes that frequently result in the delay of payment." Such mistakes include clerical errors, and incorrect or missing information.

Rest assured that making it easier to do business with them is not Aetna's -- or any other health plan's -- only motive for encouraging the use of electronic claims submission. They are going to save money. The electronic data interchange service Aetna uses for its transactions, Envoy (www.envoy.com), estimates that payers can save $1.75 to $2.00 per transaction for electronic claims processing. According to Envoy, some 900 payers are using its electronic services.

Experts agree that electronic data interchange (EDI) is a boon to administration that medical practices should be taking advantage of.

"If they are not doing electronic claims submission and electronic remittance, then they are spending a lot of dollars operationally that they don't need to," says Ms. Nelson. "That's time wasted that the staff could be following up on the phone when there is some problem with a claim."

Even if the plans you deal with do not have electronic claims, or some do and some don't, you can take advantage of automation for all your claims by outsourcing them to a claims clearinghouse, Ms. Nelson says. The clearinghouse will take all your claims electronically, and then disburse them to your payers, in whatever form they will accept.

Electronic remittance, where payments are posted directly to your account by the payer, is less widely used by practices right now than electronic claims processing. It may be less widely available -- Aetna, for example does not yet make payments electronically -- or, Ms. Nelson suspects, practice managers may not want to give up control over the checks.

But, she says, "It's a tremendous timesaver, and time equates to money. All Medicare [carriers] will remit electronically, and that's a big payer source."

Of course, EDI does you no good if you're not yet connected -- to a PC and the Internet. Data from the American Medical Association indicates that only 37 percent of doctors use the Internet in their offices. "I think if doctors examined how their staff spent their time, they would recognize that [going on-line] is critical," says Ms. Nelson.

Dr. Kelly wants physicians to develop what he calls the "Internet habit." He describes that as a point "where physicians recognize that there are certain processes which they can do much more efficiently if they have the right information available electronically, rather than looking for paper sources." He would like to see an Internet-connected PC in every physician's office by the end of this calendar year.

Aetna U.S. Healthcare is going to extraordinary lengths to help make that happen. In June, the company announced partnerships with Hewlett Packard, the computer manufacturer, and Net Zero, an Internet Service Provider, to provide discounted PCs, free Internet access and e-mail to physicians, medical office staff and other health professionals. You don't even have to be a member of one of Aetna U.S.Healthcare's networks to take advantage. (Call 1-888-Aetna-49 for more information.)

Efforts such as Aetna U.S. Healthcare's are a reflection of a more conciliatory tone that Mr. Du Moulin has noticed recently in his dealings with health plans.

"What we're seeing in the past year is managed-care companies approaching the provider community and saying 'What can we do to work with you to address these issues?'"

Indeed, the American Association of Health Plans (AAHP) recently announced an initiative to encourage their members to take steps to streamline administrative procedures and make them more "transparent" -- a direct response, AAHP says, to specific concerns raised by physicians.

A technological transformation of health plan transactions with physicians' offices is clearly underway. Perhaps this emerging trend, coupled with a significant attitude shift on the part of some third-party payers, will allow physicians in the near future to see some light at the end of the "hassle factor" tunnel.

Written by: Moira Flaherty