EFTs and ERAs

More and more insurance carriers are encouraging not only EFT, electronic funds transfer, but also ERAs, electronic remittance advice. Some of us are still trying to figure out the difference. EFT is strictly the transferring of funds being paid by the insurance carrier into the provider’s bank account instead of mailing them a paper check. ERAs are when the explanation of benefits statement (EOB) are received in an electronic format instead of a paper EOB. Once the ERA is downloaded you can then print out a paper copy.

I personally love both the EFT and the ERAs. No longer do we have “the check wasn’t cashed so we put a stop payment on it and will reissue a new one.” We have just a couple of our providers who are just a bit unorganized and seemed to have quite a few “lost” checks. EFT is really convenient for those providers.

ERAs are really nice if your system is set up for autoposting. You still have to check things over but it really cuts down on the data entry. And ERAs are easily stored on your system which makes it easy to go back and access. No more pawing through a paper file of eobs searching for the right one to attach to your secondary claim.

As with electronic claims submission, we are starting to see more and more carriers beginning to require EFT and ERAs. Medicare requires EFT currently but not ERA. You can have one without the other. NYS Medicaid has also announced that they will be mandating them as will. I think we will continue to see more.

EHR – The Good, The Bad, & The Ugly

by Michele Redmond
Monday I was in one of my physician’s office and he asked me to watch a video about EHR and give him my opinion. It was a 15 minute video of Craig M Wax, D.O. speaking at an AAPS (American Association of Physicians and Surgeons) event. Dr. Wax is against EHR (electronic health records) and isn’t afraid to share why he feels this way.

As a biller EHR really doesn’t affect me much on a professional level. Some of my providers ask for my advice on what they should do as far as EHR goes, but that’s about as far as it goes. But while watching Dr. Wax’s video I did get thinking about how I feel about EHR on a personal level, not as a biller, but as a patient and it was eye opening!

First of all there are two types of EHR. The first is an EHR system that is on the physician’s server. All files are stored right in the physician’s office and can only be accessed by someone on that system. The second type is what they call “on the cloud” or web based. This means the information is stored on the internet. I will talk more about the issues with the internet based systems in a minute.

According to Dr. Wax the government says that certified EHR technology will improve quality of health outcomes, improve the efficiency of healthcare and provide privacy and security safeguards. But what does the government base these promises on? Do they actually have any proof or anything to back up these claims? Even the Wall Street Journal published an article called “Looking for EHR Benefits But Can’t Find Them”. It appears that the implementation of EHR may actually just be one massive experiment using physicians and patients as the guinea pigs.

My primary care doctor does use EHR and I have seen both pros and cons. The first con is that he walks in the room, sits down at the computer facing the wall and begins typing while he’s talking to me. Where is the face to face contact? It is kind of annoying. He is asking me what is wrong but he is not looking at me. I think it takes away some of the doctor patient relationship. On the pro side, if he sends me to one of the other specialty physicians in the building they have everything they need regarding my medical records at their fingertips.

Let’s get back to the cloud based EHR or the internet systems. The argument is that your physician can access your records from any device connected to the internet anywhere they need to access it. The first problem that pops into my mind is “who else can access it?” Now of course all those pushing EHR would immediately say that the security is top notch, etc. etc. But I’m not stupid. Sarah Palin’s personal email and President Obama’s cell phone were both hacked. Information on the internet is constantly compromised, stolen, hacked, lost, etc. There are stories on the news all the time about companies who have had their information compromised. Credit card companies, banks, etc. An employee inadvertently takes a laptop home and it gets misplaced.

According to Dr. Wax, 9 out of 10 small healthcare organizations have reported a data breech already. That’s 90%! Once PHI (personal health information) is online it can be stolen. Stealing EHR is big business. EHRs contain all of your PHI. PHI consists of your personal contact info, SS#, date of birth, possibly your credit card info and more. This brings identity theft to a whole new level.

Another thing that may be contained in your PHI is genetic information. For example, do you carry the breast cancer gene? Do you want that known? There are companies that would pay for that type of information.

Personally there is another issue I have with EHR. All of my personal conversations I have with my doctor will be able to be accessed by many. Think about that. Are you okay with that? Do you want a nurse at a hospital where you are having a CAT scan to be able to read your private conversations with your doctor?

We are assured that only authorized people will be able to access the EHRs but in my opinion there are a lot of “authorized people”. For example, will EHR allow a pediatrician in California to access records on his daughter’s ex-husband in NYC? Will he be able to check his records to monitor his alcohol use to assist his daughter with a custody battle?

I may be reaching a little far in some of my examples but I think we really need to think this through. How many times have you heard of a doctor’s office being broken into and having paper charts stolen? In my opinion, EHR is forcing patients to have their private business become public. Why does government feel that they need to force everyone to participate? I don’t know what the process is for patients or providers to opt out but I personally think that should be an option.