10 Steps towards Efficient Medical
Electronic Billing Claims Submission
by: Ms. Pinky Mcbanon
Senior Medical Billing Consultant (Dansalan Group, Inc.)
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 towards 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 Avoid using outdated ICD and CPT codes.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.
Electronic Billing Claims Submission
by: Ms. Pinky Mcbanon
Senior Medical Billing Consultant (Dansalan Group, Inc.)
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 towards 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.
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