Most people doing medical billing now are submitting at least some of their claims electronically if not most. Of course there are still a few small insurance carriers that do not accept electronic submissions yet but they are becoming obsolete. For the few billers that are still doing everything on paper, it is only a matter of time before you will be submitting electronically.
Most electronic claims are submitted thru a clearing house. Maybe you think all clearing houses are alike, but that is not true. They actually vary quite a bit in both cost and function. It is important to find the one that will work well for your needs.
We recently began using a new clearing house and we were amazed at the different functionality. The system we were using was working fine and we didn’t feel there were any problems. But when we began using the new clearing house, we realized how much more we could be doing. We have now switched almost all our claims submissions to the new clearing house.
There are a couple of things that make the clearing house work well for us. First of all, most of our claims are submitted for free. As long as we submit more than 50% of claims to commercial carriers, vs government plans, we don’t have to pay for any of our claims. Many clearing houses charge a per claim fee. For the volume that we submit, this is a huge savings. The system we were using didn’t charge a per claim fee because we actually acted as our own clearing house, but we did have to buy an expensive software and then pay for updates and support every year.
But the part that I’m most excited about is the reports that we get. We got reports from our old system but they were not as detailed and they were difficult to read. We had to sort thru the accepted claims to find the rejected claims. The new clearing house notifies us immediately when a batch is received and within an hour or two if the claims were accepted or rejected and they notify us by email. The email system works a lot better for us than having to go in and download the reports. The email comes in and you can quickly check to see if the claims were accepted or rejected. If there are rejections, you simply log on to the clearing house web site to view the rejections. There is also a place where you can go into the claim right from the website, make any changes or corrections, and resubmit right from there. It is not necessary to completely resubmit the claim from your practice management system.
Thru the website it is very easy to quickly check the status of all batches, or individual claims submitted. A claim that is initially accepted can be rejected by the insurance carrier for reasons such as insurance plan not in effect at time of service, or patient not covered under plan. The claim was originally accepted because there were no claim level errors, but the claim will not be paid for other reasons. If a claim that was initially accepted is rejected at the insurance carrier level, another email is generated, and the status of that claim is changed from accepted to rejected and the reason is displayed. This makes it very easy to check and act on rejections as they are listed very clearly.
This system allows you to be aware of claims that are not going to be paid within hours or days of the services. There are many systems that do notify you of rejections, but not all do it as clearly and quickly. Add that to no charge per claim and it’s really starting to sound pretty. Now if you are taking care of these rejections quickly, then your aging reports will be much more manageable.
Most offices lose a lot of money because they do not work their aging reports, or they do not work them well. With a good clearing house that provides detailed and fast reports, you can reduce the aging reports greatly, making them easier to work. They take less time and are not so cumbersome. You are not making unnecessary phone calls to find out about denials that can be found in the electronic reports. In our office, the aging reports are not the most desired job so reducing them is greatly appreciated.
A lot of insurance carriers have an online claim system that will let you submit claims directly thru their web site. This can be nice, but it requires double entry of the claims. You have to enter them into your practice management system to track them, then enter them into the web system. We don’t find this is very cost efficient in most cases, but there are a few that we do this with. They have something called “real time submission” that allows you to see immediately if payment is going to be made and how much will be paid. If it is going to be denied, the reason is there instantaneously.
Whatever system you decide to use what is important is that it works for you. Recognize that they are not all the same, investigate what they offer and what they charge and make sure that they submit to the carriers that you will need. It is important to make sure that you are checking your reports and fixing the denials. This will save you a lot in the long run. It is also important to learn the system you are using so that you get the most out of it.