Electronic medical billing has greatly improved the way claims are processed and paid, but this does not mean that the task is very easy to do. However, it is still possible to have trouble-free submissions if there is proper training and good practices to use electronic submission efficiently. Electronic medical billing has a lot of benefits. It will take a shorter time to process and reimburse payments compared to paper billing which takes weeks to complete. It reduces errors and lost claims almost completely. Transmissions are also fully encrypted 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. Aside from this monthly flat fee, no other payments should be made. Full compliance with HIPAA is also required for the clearing house. 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. 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.
When you enter your patient’s information, make sure to have the patient’s insurance ID number entered 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.
Use proper modifiers. Errors are easily picked up by electronic billing systems. 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.
Generate reports upon submission. Ensure that the claims are accepted. IF the generated report says that the claim is rejected, immediately call the insurance company, then resubmit your claims. It is very important to read all your electronic submission receipts and reports.
Keeping track of your claims should always be done. You have a powerful tool if you medical billing software has a tracer tool. Pending and unpaid claims can easily be tracked. If your claims are denied or rejected, follow them up persistently.
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.