Now that most practices are using some sort of electronic claims submission solution, there are lot's of snafus or lessons learned that you may want to know to improve the process. By the way, if you aren't submitting your claims electronically yet, you better get to it. You are losing money and time for no reason at all. It doesn't matter what type of practice you are in.

Most electronic claims submissions are either done, using software pushing claims through a clearing house or directly to an insurance company. If you are accepting more than one or two insurance companies, you should be using a clearinghouse. They can submit claims to all the insurance companies and allow you to only have to use one interface for submitting claims.

One of the inefficient methods doctors or practice management personnel will use is to have one system for handling patient data like scheduling and patient charts etc.. Then when it comes to submitting claims, have to re-enter patient information into another application or web interface to submit a claim. This is highly inefficient on many levels. Think about the duplicate work going into re-entering patient information alone. Another issue is the reconciliation of payments from payers (insurance companies) to the doctor for specific patients. You have to receive checks and EOBs, then manually reconcile those back into the practice management system.

The above problem can easily be solved by using a practice management solution that allows electronic claims submission and reconciliation as well. This not only reduces redundant work, but speeds up payment and practice efficiency by allowing time to spent on aged accounts and collections.

Another inefficient method that some practices use is, hiring non-professionals to do their billing work. There many issues with this, but I'll try to touch on a few to give you an idea of how inefficient it is. Most of the time employees who are paid hourly, are not motivated in any way to get the practice paid on anything that is going to be hard work to get. For example: Sometimes it takes multiple phone calls and a couple appeals forms just to get claims paid. It doesn't matter if the claim is worth $25 or $5,000, if it is hard, complicated or laboring, most likely a low paid hourly employee isn't motivated to help get the practice paid. At least not consistently. This is why i suggest that every practice should look into bringing in professionals to do the billing. Whether it is bringing an experienced veteran that has proved to get aged accounts paid or partnering with a medical billing company. Either of these 2 options is going to guarantee better cash flow and reimbursement rates.

Article Source: http://EzineArticles.com/?expert=Eric_Blow
http://EzineArticles.com/?How-to-Improve-Insurance-Claims-Efficiently&id=3382025

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