Submitting Electronic Claim Attachments
One of the major strains on healthcare providers is the dependence on paper and manual procedures. This duo frequently adds up to harmful mistakes and costly denials, which demand significantly more time and effort to resolve, if left unchecked.
Among the manual processes most difficult to manage are claim attachments that require significant time for teams to go through the requirements, collect and send the needed documentation and fulfill follow-up procedures.
In line with the CAQH Index, the healthcare industry spends around $600 million each year exchanging attachments, with a number of providers spending somewhere between 10-30 minutes manually submitting an attachment to a payor.
What’s the Solution?
Getting paid quickly and correctly is a major concern for many healthcare providers. Electronic claim submission is one tool practitioners are employing progressively more to accelerate the claim reimbursement process. Practitioners are discovering that sending out insurance claims electronically to health care payors can boost their practice’s cash flow and help modernize their billing procedures.
This movement toward better use of electronic claims has also been driven by the prospect that an increasing number of insurers will eventually expect electronic claim submission in an attempt to cut their costs. Medicare payment policies have also advanced the trend by forcing hospitals and clinics to submit all Medicare claims electronically.
What is an Electronic Claim?
An electronic claim is any medical claim created entirely digitally without any paper or printing, usually within an electronic health record (EHR) or electronic medical record (EMR) software that includes a medical practice management system.
Electronic claims in medical billing are rapidly becoming the industry standard. Surely, you’ve noticed this and if you’re not already submitting most or all of your claims electronically, you might be thinking of making the switch.
If you’re taking into account how such a solution could benefit your healthcare organization, read on to discover about those vital areas it can improve upon.
Why Submit Claims Electronically?
- Increase accuracy and cut down on claim rejections. While paper claims are often refused due to mistakes, omissions or other issues, submitting claims electronically can result in fewer lost or incomplete claims.
- Reduce interruptions to your cash flow. Claims submitted electronically are processed more quickly, resulting in quicker payment and a boost in cash flow.
- Creating and submitting manual claims requires plenty of front-office staff time, not to mention a budget for postage. Neither of these conditions apply to electronic claims. In fact, research has found that switching from manual to electronic billing can lead to annual cost savings as high as 60%.
- Improve accuracy and productivity with fewer full-time employees, while significantly reducing administrative costs. If you retain those employees, they can now work on more patient-centric tasks.
- Claim scrubbing is improved. Even the most experienced medical billers and coders are bound to miss errors when double-checking claims. Computers are much more accurate. Claim scrubbers, which are fully automated, rapidly catch claim errors and flag them for correction before payor submission.
- Eases claim tracking. If you send claims by postal mail, you won’t know they’ve reached the insurer unless you pay extra for tracking. Even if you do pay for tracking, you won’t know your claim’s status after delivery until the payor sends you an acceptance, rejection or denial in the mail. With electronic claims, you can see your claims’ real-time status every step of the way via a detailed audit trail.
- More accurate accounts receivable. You’re no doubt well aware that a considerable amount of your practice’s potential revenue and cash are held up in accounts receivable (AR). You’re also most likely acquainted with the annoyances that come with maintaining accurate tabs on your AR. Since electronic claims speed up the reimbursement process and track all claims, they simplify and enhance everything AR.
How to Submit Electronic Claims
You have two options for submitting electronic claims in medical billing:
- Self-serving electronic claims. If you manage your electronic claim creation and submission in-house, your method is self-service. For such self-service electronic claims, either practitioners like you or, more often, your front-office staff, will produce and submit any claims in question. The self-service model is usually quite clear-cut if your practice works with comparatively few payors. In this case, each payor has particular software you can use to produce and file your claims. Things get a bit more difficult, however, if you work with a number of payors.
- Full-service electronic claims. Full-service electronic claims are practically identical to outsourced medical billing. Third-party medical billing firms normally require only your patients’ basic information and a summation of the services you delivered to produce an electronic claim. They can then swiftly transform this data into accurately formatted and coded claims. Before submitting these claims, the billing service will also run them through a claim scrubber to boost accuracy.
True, you might very well be concerned that outsourced medical billing can rapidly become too costly. However, a more extensive assessment of outsourced medical billing may well demonstrate that outsourcing is more than worth the cost. Simply think about the money lost to mistakes you or your thinly spread staff make when hurrying through claims. This alone could go beyond the cost of the outsourced medical billing. Fact is, the upfront costs of outsourced medical billing services often pay for themselves in the long run.
At Medwave, our medical billing protocol includes robotic process automation. This creates an even smoother revenue cycle for our clients, through automation.
