The Beginner’s Guide to Billing

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Efficient Medical Electronic Billing Claims Submission to Avoid Denials

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. Compared to paper billing which takes weeks to complete, electronic medical billing take only around 3 days to process and reimburse payments. With this system the possibility of errors and lost claims are significantly reduced. 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. Choose a clearing house that complies with HIPAA rules and regulations. You can find many of these clearing houses where you can submit your claims electronically or through a modem directly from your computer.

It is important that you have all the list of payors’ numbers 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 billing system should also include your tax number.

Enter your patient’s insurance ID number correctly. Don’t put any other characters in the insurance ID number aside from numbers only. Enter the insurance ID number without any asterisks or dashes.

Ensure that there is prior authorization or that you have verified coverage for the patient for that date of service.

Use proper modifiers. Since electronic systems are intelligent systems, every error is easily picked up. Non-numeric modifiers use big letters.

Make sure that you double check the claims that you file. Make sure that there is no missing information before you submit your claims. Claims should be edited so that there will be no errors. Then submit your file.

Make sure that reports are generated right after submission. The report should indicate that the claims are accepted. Call the insurance and resubmit the claim if you see that it is rejected. It is very important to read all your electronic submission receipts and reports.

You should always keep track of your claims. Medical billing software with a tracer tool is a system which is very powerful. Pending and unpaid claims can easily be tracked. 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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