Getting To The Point – Claims

Guide to Efficient Submission of Medical Billing Claims

You might think that because medical billing has gone electronic, there will be no more problems experienced with it. But, if you are trained and if you practice the ways to efficiently maximize the use of electronic submission, then it will ensure that your claims submissions will not encounter any hindrances. 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. With this system the possibility of errors and lost claims are significantly reduced. There is full encryption of transmissions and it is compliant with HIPAA rules and guidelines.

Choose a clearing house for your healthcare facility that will charge you a monthly flat fee for all your submissions and resubmissions no matter how many you submit. Don’t pay anything other than the monthly flat fee. Choose a clearing house that complies with HIPAA rules and regulations. It will not be difficult finding a good clearing house for your electronic medical billing submissions.

The list of payors’ numbers with the insurances you bill and participate with should be included. ON the patient’s insurance information, the payor number identifies where your claims will go. You should also include your tax number in your billing system.

Enter your patient’s insurance ID number correctly. Simply put the numbers without 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.

When you use modifiers, make sure that you are using the proper ones. Since electronic systems are intelligent systems, every error is easily picked up. Make sure that you non-numeric modifiers are always in capital letters.

Preview all the claims when creating the file. Before submissions, check for missing information. Claims should be edited so that there will be no errors. Then submit your file.

After submitting he claims, generate reports. The report should indicate that the claims are accepted. IF the generated report says that the claim is rejected, immediately call the insurance company, then resubmit your claims. Make sure to read all your electronic submission receipts and reports.

Claims should be kept track of. You have a powerful tool if you medical billing software has a tracer tool. 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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