5 mins read
October 19, 2020
The modern healthcare world started shifting towards electronic claim submission for timely claim payments. So if you haven’t switched over to electronic claim submission, may cause your practice to decline in value and effectiveness. You may be thinking about how to speed up your claim process. The easy way is to go with the best medical billing software that includes provisions for electronic claims submission. Here is how electronic claim submission speeds up your claim process and results with more timely payments.
A Healthcare Business and Technology article on medical claims processing says processing delays due to errors cost providers an estimated $125 billion every year.
The way toward getting repayment for services has gotten so long and complex and numerous suppliers have recently accepted delays as a necessary evil. Staff may assume if the patient has coverage, as long as they eventually receive payment, there’s no need to hurry the procedure.
The American Medical Association (AMA) says claims that are rejected, underpaid, denied, or in need of re-submission cost individual practices as much as $100,000 a month.
So speedy claim processing matters a lot and it can be successfully achieved via electronic claim submission
What happens in manual claim processing? It’s full of paperwork by hand and it will be shared with the insurance agency via mail. So here, when a person fills out the claim, there are a lot of chances to misspell names and miss out on important data which leads to claim errors. Again from the payer side, when they input the shared data’s into their system, it creates another opportunity for errors which will slow the claim processing.
Now coming to electronic claim processing, here the claims are filed electronically which automatically reduces the chances of Claim errors and improves accuracy, so the claims are processed more quickly. The best medical billing software with an electronic claim submission feature often won’t allow medical coders to submit bills without completing the important information.
So this ultimately reduces the number of claims rejected for blank fields. The modern billing software also includes scrubbing tools that check for common mistakes in the claim submission process. So the common mistakes like misspelled words will be avoided with electronic claim submission.
Nowadays, healthcare providers are using optical character recognition (OCR) tool to input data and create electronic claims. The ultimate specialty of this tool is, it will scan the data from the documents and insert it into the appropriate claim field – thus reducing the claim errors.
Before proceeding with electronic claim submission, the physician practice should first identify what kind of electronic claim submission is correct for the practice setting. There are two ways for electronic claim transmission:
1. Dial-up method: This method uses two modes for the claim submission process- a telephone line or digital subscriber line
2. The Internet:This method provides a secure direct transmittal of claims submission to health plans over the Internet and ultimately eliminates the need for transmittal software.
When working on claims, errors are the common things that happen each day, so it’s better to go with electronic claim submission to cut down the claim errors and to speed up your claim process. When a person entering information for a claim, of course, it’s possible to make errors such as transcription errors. Electronic claim submission won’t be conceivable if there are significant mistakes. So here the software alerts the representative on the spot and prompts for a fix before permitting the claim to be submitted.
|S.No||Steps To Achieve||Information To Verify|
|1||Ensure right and updated patient data on claims||Patient demographic information, Policy information, Medical information|
|2||Verify patient eligibility and benefits at-least two days before the date of service.||Primary, secondary, and if applicable tertiary insurances, copays and deductibles, services or procedure coverage, policy effective dates, in-network/ out-of-network benefits entitlement.|
|3||Procedure authorization at-least five days before the date of service.||Type of procedure, verifying if the procedure is covered under the patient plan type.|
|4||Follow carrier-specific coding guidelines||CPT and ICD compatibility, the electronic submission process|
|5||Ensure correct modifier usage.||Application of correct modifier, appending the modifier on the correct procedure|
|6||Undertake quality checks before claim submission||Examine each claim for errors (coding & submission errors) before submission.|
|7||Detailed medical documentation||Medical history, need of service documentation, procedure documentation, patient medication history.|
69% of electronic claims are processed in seven days when compared to 29% of paper claims. Our medical billing software with electronic claim submission feature speed up your claim process by eliminating errors and offer clean claims lead to faster reimbursements and organized workflow.