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(5) Avoid using outdated ICD and CPT codes.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.
*** another useful article from Ms. Pinky
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