Getting Creative With Claims Advice

Efficient Medical Electronic Billing Claims Submission to Avoid Denials

Although we have benefited from using electronic medical billing, we should not think that the task is a simple one. However, it is still possible to have trouble-free submissions if there is proper training and good practices to use electronic submission efficiently. The benefits of electronic medical billing has benefitted the healthcare industry in many ways. It will take a shorter time to process and reimburse payments compared to paper billing which takes weeks to complete. The accuracy percentage is almost perfect so errors and lost claims are reduced. There is full encryption of transmissions and it is compliant with HIPAA rules and guidelines.

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.

Make sure that you list down all of the numbers of your payor that you bill and participate with. 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.

Enter your patient’s insurance ID number correctly. Only numbers should be used and avoid using any other characters. Don’t use asterisks or dashes in when you enter this information.

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. Non-numeric modifiers use big letters.

Make sure that you double check the claims that you file. Before submissions, check for missing information. Before submitting your files, edit your claims so there will be no errors.

After submitting he claims, generate reports. Make sure that your claims are accepted. Call the insurance and resubmit the claim if you see that it is rejected. Make sure to read all your electronic submission receipts and reports.

Keeping track of your claims should always be done. Medical billing software with a tracer tool is a system which is very powerful. You can track your pending and unpaid claims. You have to be persistent in following up denied or rejected claims.

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.

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