Explanation of Benefit Solutions

Medical practices have a number of challenges associated with Explanation of Benefit (EOB) forms.  As reimbursements shrink and regulations increase, practices are forced to find ways to reduce administrative overhead so that they can stay healthy.

While many large payers provide EFT (Electronic Fund Transfer) payments and electronic EOB forms, most practices still get 30 percent or more of their EOB forms in paper form.  This creates a number of pain points and hidden administrative costs.

EOB’s must be kept for seven years.  Many practices pay for off-site storage or consume valuable office space storing EOB forms.

Finding patient information is close to impossible since multiple patients are listed on each form.  Many practices will call the insurance company for reprints because it’s “faster” than searching through the paper EOBs, but this can often lead to huge amounts of wasted time and effort.  The call to the insurance company can take minutes as you navigate phone trees and wait for a customer service representative.  The reprint may take days to arrive and then you have to call the patient back, which often results in “phone tag”.

SIS NW can scan and index your EOB’s so that they can be instantly viewed and you can resolve patient inquiries immediately while still on the phone with them, vastly improving customer service and increasing efficiency.  The electronic EOB forms can be searched in multiple ways, and you can build ad-hoc searches for research purposes.  EOB’s are archived for the required seven years so that you can free up office space and/or eliminate off-site storage.  Electronic images received from payers can also be indexed and stored in the portal and this service can be combined with our Medical Lockbox solution to help improve cash flow and virtually eliminate the possibility of fraud.

It is also possible to convert paper EOB forms into Medicare compliant 835 EFT files for auto-posting.

Customers typically report that they realize savings of approximately $10,000 per year per provider in administrative costs.  The larger the practice, the more savings and productivity improvements are realized. Staff members can be re-assigned to focus more time and effort on collections and other patient care and revenue generating opportunities.