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E-Billing
HIPAA
Additional Resources
E-Billing
Printing large quantities of paper invoices, stuffing them into envelopes, and then sending them via
an increasingly expensive “snail mail” system is not anyone’s idea of efficient
billing. Electronic transmittal of billing information is a faster and in many cases more economical
way to send invoice information. This is why all versions of SYSTOC are capable of exporting billing
data electronically, a process referred to as “e-billing.”
Until now, OHR has set up e-billing for interested customers on a fairly individualized basis,
providing software to generate the necessary files, which were then sent from the clinic straight to
the chosen clearinghouse destination. While this has been successful for the customers that have
tried it, the setup and testing process is very labor-intensive.
A new service called
OHReBill™ is now in testing, and this will streamline the process to
provide one-step electronic billing for clinics using SYSTOC. The clinic simply processes all the
invoices, which they would do whether they were electronic or not, then clicks on a button to send
the electronic ones on their way. OHR acts as the initial clearinghouse, electronically sorting the
invoices and supporting medical documentation according to the desired destination, which is an
electronic bills clearinghouse. The clearinghouse is responsible for the ultimate submission of
claims to the insurance provider. The clearinghouse may also perform services such as verifying or
pre-approving invoices, or it may simply forward the bill in electronic format or as paper if the
payer is not capable of receiving the invoice electronically.
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Prior to transmittal, SYSTOC invoicing information goes through a level of electronic error checking
to determine if critical data, such as ICD-9 codes, are missing. Invoices flagged as missing data
must be corrected (e.g., the ICD-9 added) before they can successfully be exported. If the clinic
keeps the medical record in the Treatment memo, as it should, the medical record for a WC case will
be forwarded along with the invoice.
HIPAA
All medical facilities are rightly concerned about HIPAA.
According to the current HIPAA rules, the only data that must conform to the specified electronic
standards are those sent to the final recipient. As long as information exported from SYSTOC is
transmitted to at least one “go between” prior to reaching its final destination, there
are no HIPAA restrictions regarding the format in which data must be transmitted. Even so,
Occupational Health Research takes data safety very seriously, and uses industry-standard encryption
for both the data it receives and the data it sends.
OHR has two intermediary organizations already signed up for the initial launch of OHReBill,
and a third will be up and running soon. The clearinghouses involved so far are EM3, HMonline, and
P2P Link. EM3 started out offering billing review services to Concentra clinics, but has negotiated
an agreement with OHR to offer the same services to SYSTOC users—at the same price. Once SYSTOC
users are “certified” by EM3, that company will provide pre-approval of billing and
guarantee prompt payment of medical claims. Health Management Online, a billing service that
originated on the east coast, is currently in the process of expanding its services toward the west
coast as well. P2P Link is an initiative of The Hartford Financial Services Group.
Clearly, OHReBill makes electronic billing quite simple for SYSTOC clients, and it will get
even better as more clearinghouses are added to the mix. The service could result in significant
savings of time and money. Clinic managers investigating ways to increase their efficiency and
improve cash flow should consider electronic billing through SYSTOC.
If you would like additional information about
OHReBill, please e-mail us at solutions@systoc.com.
Additional
Resources
Em3
HmOnline
P2P
Link
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