However your practice handles billing, it’s critical to understand the role ERAs play in your revenue cycle. Electronic remittance advice (ERA) explains how a health insurance company or health plan has paid and/or adjusted claims from a medical provider. Often, this includes a portion paid by the provider, a reduction in the initially billed amount due to agreements with the plan provider, and a balance owed by the patient that may include a co-pay, co-insurance, deductible, or services not covered. ERAs are a key part of the medical billing process for your behavioral health practice.
What is an ERA?
In medical billing, the older, paper explanation of benefits (EOB) has now largely been replaced by the electronic remittance advice (ERA). Typically, your practice will upload batches of claims on a regular basis to a claims clearinghouse, which then sends those claims on to the relevant insurers. Once the payer processes the claim, they send it back to the clearinghouse as an ERA, which you can then access either through the clearinghouse or your EHR.
An ERA in medical billing is, to be technical, a text-based file that explains what the payer covered, how much they will not pay, and what the patient is expected to pay (for example, co-pays and co-insurance). An ERA may have a file extension such as .txt, .dat, .x12, or .835, which contains text and computer code in a standardized format to aid processing by billing software. An ERA file is not a PDF or Excel spreadsheet, although the right software can process the data and export it, if needed, in these or other formats.
How Do ERAs Fit Into the Billing Process?
The ERA is a vital part of the medical billing process. If a claim is rejected, the ERA will let you know when and why, and gives billers the necessary info to address the issue and resubmit the claim. It is important to process and respond to ERAs quickly so that your practice can update patient accounts. ERAs are also your primary source of info for informing patients what was paid, what was not paid, the reason for any denials, and what they owe. ERAs also inform whether it’s necessary for them to resolve any issues with their insurance company or health plan.
ERAs are superior to paper remittances because they allow quicker processing and the potential to address errors promptly. In the old days, paper remittances would often take months to be returned, and they required significant manual processing with many potential ways to be lost or fall through the cracks. Now ERAs in medical billing, especially when paired with the right HIPPA-complaint billing and electronic health records (EHR) software, can simplify your practice’s billing processes while improving your revenue cycle, and most importantly, the patients experience.
Billing ERAs in Your EHR
The right software can take the hassle out of processing and transmitting claims, downloading and processing ERAs, correcting and resubmitting denied claims, updating patient account records, notifying patients, and collecting co-pays and co-insurance payments from patients. Valant is an electronic health records (EHR) software with fully integrated billing software seamlessly integrated with two leading clearinghouses. Valant makes everything from checking eligibility, to submitting claims, to managing ERAs as easy as possible.
In addition, Valant includes a billing dashboard with easy navigation, color coding to sort claims, a “superbill” statement generator that patients can directly access in their patient portal, one-click automatic posting of returned claims, and more. This saves you and your staff time, increases your ability to collect efficiently, and helps you focus on what matters—caring for your patients.
Valant can help your behavioral health practice handle billing ERAs with ease. We would love to show you a free, live demonstration, so you can learn more!
