Electronic billing is not that easy as you might think. But there is always a good training,
practice and ways to efficiently maximize the use of electronic billing submission. There are
many advantages why medical providers must submit claims by electronic. One is because
the processing and reimbursement time is at least within 72 hours compared to a paper billing
that may take up to 3 weeks. Electronic submission reduces errors and lost of claims by 98%.
Transmission is fully encrypted and compliant with HIPAA rules and guidelines.
I would like to point out 10 Steps for Efficient Medical Electronic Billing Claims Submission:
(1) Assuming you have the Medical Billing System in your office, next step is to sign up with a clearinghouse with a reasonable monthly flat fee regardless how many and how much
claims you can submit and resubmit. Make sure you do not pay any other fees on top of the flat
fee. The clearing house must be fully compliant with HIPAA. There are many available vendors
out there. You can submit claims through web-based solution or through a modem directly you’
re your computer. I will talk about this on the later part of this article.
(2) Make sure you have all the list of payors’ number with the insurances you bill and participate with. This payor number will identify where your claims will go based on the patient’s insurance information. Your tax number should also be in your billing system
(3) By entering your patient’s information. One information that you have to be careful is the
patient’s insurance ID number. I strongly suggest to input the number as is without any other characters other than alphanumeric characters. In other words, avoid using an asterisk and dashes on this field.
(4) Make sure you have obtained prior authorization or you have verified coverage for the patient for that date of service
(5) Avoid using outdated ICD and CPT codes. Make sure your diagnosis codes (primary or
secondary or tertiary) does not require a 5th digit.
(6) Make sure you use proper modifiers. Nowadays, electronic billing systems are
intelligent enough to pick up errors. Normally non-numeric modifiers are always in big letters
(7) When you create the file, you have the option to preview all the claims. Before you
submit this file electronically, make sure to check for missing information. Edit the claims for
errors. Finally submit your file.
(8) Generate reports after you submit the claims. Make sure all claims are said to be
"accepted". If you see reason code as "rejected"--- immediately correct the claim, call the
insurance and resubmit the claim. Always read all your electronic transmission
receipts/reports!
(9) Keep track of your claims. A medical billing software with a tracer tool is a very powerful
system. As you can track your pending/waiting and unpaid claims. Persistent follow ups for
previously denied and rejected claims is a must.
(10) Last but not the least, generate a report to reconcile bills to appointments. This way
you know which appointment dates was not billed and no superbills was generated.
If you want to eliminate all the above work plus the headache and aggravation for claims
rejections, denied and underpayments, the best way is to outsource your billing needs to an
experienced full service medical billing service company. This way, it also saves you all other
administrative and manpower overhead expenses. Make sure you consider a company that
specialize your area of specialty and who knows your business. Making this choice and the
decision is very critical to your practice as this billing service becomes your backbone for
revenues.
