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Guide to Efficient Submission of Medical Billing Claims

Although we have benefited from using electronic medical billing, we should not think that the task is a simple one. 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. 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. There is full encryption of transmissions 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. You should not pay any other fees on top of that flat fee. Full compliance with HIPAA is also required for the clearing house. You can find many of these clearing houses where you can submit your claims electronically or through a modem directly from your computer.

The list of payors’ numbers with the insurances you bill and participate with should be included. This payor number will identify where your claims will go based on the patient’s insurance information. Make sure that your tax number is in your billing system.

When you enter your patient’s information, make sure to have the patient’s insurance ID number entered correctly. Only numbers should be used and avoid using any other characters. Enter the insurance ID number without any asterisks or dashes.

Before filing your medical billing, you need to check if there is proper authorization or that you have verified the patient’s insurance coverage for that date of service.

Proper modifiers should be used. Electronic billing systems are intelligent systems that can easily pick up error. Capitalize all non-numeric modifiers.

When creating your file, preview all claims. 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. Make sure that your 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.

You should always keep track of your claims. You have a powerful tool if you medical billing software has a tracer tool. You can track your pending and unpaid claims. 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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