Is electronic billing the best way to submit your medical claims?
There is so much publicity about Electronic billing of medical claims. If you haven’t submitted your claims electronically yet, you’re probably too embarrassed to admit it. And if so, you are probably wondering if the method you are using is the best one. Which is the real truth behind electronic invoicing?
Many of the larger insurance companies are really pushing providers to submit claims electronically. Some even call the provider’s offices and tell them they are require electronic filings on a certain date and that they will It no longer accepts paper claims. Others offer incentives to submit electronically, such as faster payment, or even no authorization for services is required if claims are submitted electronically.
Simply put, the real question for a provider is “Is electronic invoicing really necessary for my practice” and “what will it require of me”?
For the first question, I think everyone should realize that with changes in technology electronic medical claim filing is inevitable. Today’s society is moving towards paperless transactions in many ways.
The second question will depend on many things, such as how big or small your office is, how much equipment you already have, and how up-to-date it is.
One of the biggest misconceptions about electronic invoicing is that it greatly simplifies invoicing in your office. Somehow it does, but it presents you with a completely different set of tasks that you didn’t have before. I’m not implying that I do anything more difficult. Only there are things that go along with electronic invoicing that you didn’t have to do before, like reading and acting on reports and maintaining and updating electronic software.
When you file a paper claim, the claim is received and processed, or you never hear a thing. Hopefully, in the latter case, your staff will call and check your status after 30 days. Whether your paper claim has complete and accurate information or not, it will be handled the same way. You will receive claim payment or an explanation of benefits showing the reason for the denial.
When you submit claims electronically, it’s not that easy. First, you will receive a report informing you if your batch of electronic claims was accepted or rejected. If a claim has incorrect data, such as an incorrect date of birth, it will be rejected before it reaches the insurance companies’ claims processing system. You will receive a report, usually within 24 to 48 hours, showing all denied claims and the reasons for denials. You will also receive a report showing the claims that were accepted without errors.
It is very helpful to receive such a prompt notice that your claim contained incorrect information; however, now you must ensure that your staff can verify this report and take the time to find and correct the necessary information.
What electronic invoicing is actually doing is letting you know beforehand that you have specific claim issues. When you file them on paper, you generally don’t find out about problem claims until you run a follow-up report and call the insurance companies. So by submitting your claims electronically, you are not eliminating all problem claims, you are finding out sooner.
Once you decide to take the step towards electronic invoicing, there are still options to be made. Is the practice management system you are currently using capable of submitting claims electronically? Otherwise, you will need to update or change your software. You will need to determine how you will submit your claims to insurance companies. A clearinghouse may be the best option, or if you are a larger practice or billing service, you may want to consider software that allows you to act as your own clearinghouse.
In any event, if you are not yet submitting your claims electronically, it would probably be wise to start researching your options. A good place to start is to contact your practice management system support and ask if they recommend any particular method. Another way is to ask your colleagues. Electronic claim filing is a big step and should not be taken lightly.
Copyright 2006 Michele Redmond