Efficient Medical Electronic Billing Claims Submission to Avoid Denials
Electronic medical billing has greatly improved the way claims are processed and paid, but this does not mean that the task is very easy to do. However, it is still possible to have trouble-free submissions if there is proper training and good practices to use electronic submission efficiently. There are many benefits of using electronic medical billing. With electronic medical billing, insurance pays claims within 3 days which is a lot shorter compared to around 3 weeks for paper billing. It reduces errors and lost claims almost completely. Encryption is done with submissions and HIPAA rules and guidelines are followed.
If you have an electronic medical billing system in your facility, it is important that you sign up with a clearinghouse that charges a reasonable monthly flat fee regardless of how many claims you can submit and resubmit. You should not pay any other fees on top of that flat fee. The clearing house should also be compliant with HIPAA rules and regulations. There is no trouble looking for a good clearing house to use for your electronic medical billing submissions.
The list of payors’ numbers with the insurances you bill and participate with should be included. The payor’s number will indicate what insurance company pays for the medical claims and this is found in the patient’s insurance information. Make sure that your tax number is in your billing system.
When you enter your patient’s information, make sure to have the patient’s insurance ID number entered correctly. Only numbers should be used and avoid using any other characters. Enter the insurance ID number without any asterisks or dashes.
Ensure that there is prior authorization or that you have verified coverage for the patient for that date of service.
Proper modifiers should be used. Electronic billing systems are intelligent systems that can easily pick up error. Make sure that you non-numeric modifiers are always in capital letters.
When creating your file, preview all claims. Check for missing information before submitting your file electronic ally. Make sure you edit the claims for errors before submitting.
Make sure that reports are generated right after submission. The report should indicate that the claims are accepted. When you see that the claim is rejected, immediately correct the claim by calling the insurance and resubmitting it. Make sure to read all your electronic submission receipts and reports.
You should always keep track of your claims. If your system has a tracer tool, then it will be easy to keep track of your claims. You will know if your claims are still pending or still unpaid. If your claims are denied or rejected, follow them up persistently.
Outsourcing your billing needs to an experienced full service medical billing company is an option you can take if this task is too much for your facility to take and to remove the headache of following up denied, rejected, or underpaid claims.