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. This guide to electronic claims can help you transition. Read on to learn why electronic claims might be right for you and how to get started.
An electronic claim is any medical claim created entirely digitally without any paper or printing, usually within a medical software solution that includes a medical practice management system. You can create and file them yourself or outsource the process to medical billing services. Our medical billing best picks page can point you to the service best for your practice’s needs. Once you’re set up with the right service, you can submit your claims electronically to payers rather than sending paper HCFA forms by mail.
In 2013, the American Medical Association and the Connecticut State Medical Society published a joint paper detailing the benefits of using electronic claims in medical billing. The two healthcare authorities indicated these key benefits of electronic claims:
Ditching manual processes in favor of submitting electronic claims can cut your costs by up to 60%.
You have two options for submitting electronic claims in medical billing:
If you handle your electronic claim creation and su `bmission in-house, your process is self-service. Your choice of medical billing partner can determine whether your claims process is self-service. For example, since athenahealth’s revenue cycle management services require that you keep a medical biller in-house, your process will be at least partially self-service.
For self-service electronic claims, either practitioners like you or, more commonly, your front-office staff will create and submit the claims in question. The self-service model is often straightforward if your practice works with relatively few payers. In this case, each payer likely has specific software you can use to create and file your claims. Things get slightly more complicated if you work with several payers.
Multi-payer practices typically turn to integrated clearinghouses to reduce their billing complexity, but doing so leaves you with a choice. Do you submit files you’ve created, or do you enter data directly into the clearinghouse? File submission can be a viable choice if your practice management software (PMS) can easily compile claims into a single file. Data entry is better if you lack PMS or prefer to fill out electronic claims yourself.
Of course, file submission and data entry somewhat de-automate the electronic claims filing process. However, they can be considerably less costly than fully outsourcing your medical billing. That said, they can get expensive if you add functions for insurance information checks, electronic remittance advice (ERA) statements and other things. Many practices find it worthwhile to pay for the full service that comes with outsourced medical billing.
Full-service electronic claims are virtually synonymous with outsourced medical billing. Third-party medical billing companies typically need just your patients’ basic information and a summary of the services you provided to create electronic claims. They can then quickly convert this information into properly formatted and coded claims. Before submitting these claims to payers, the billing service will run them through claim scrubbers to maximize accuracy.
Your medical billing service will also oversee everything that happens between when your claim is submitted and when you’re reimbursed. If claims are rejected or denied, your medical billing service will handle resubmission or seek patient payment. For transparency throughout the process, you can keep track of your claims’ real-time progress through your medical billing company’s software. User-friendly options such as Kareo are especially helpful for navigating the muck and mire of what’s often a convoluted process.
Medical billing services result in an extremely hands-off approach to your electronic claims. For thinly spread practices, this approach is invaluable – well, until you consider the cost. Most medical billing companies retain a percentage of your practice’s monthly collections – typically as low as 2% and as high as 9% – for their work.
Most third-party medical billers charge 2% to 9% of your practice’s monthly collections for their services.
You might be worried that outsourced medical billing can quickly become unaffordable. However, a broader view of medical billing may show that outsourcing is worth the cost. Think about the money lost to the errors you or your thinly spread staff often make when rushing through claims. That alone can exceed the cost of outsourced medical billing. The upfront costs of outsourced medical billing services often pay for themselves in the long run.