Step 2: Claims Submission
The first post in our blog series last week showed you how improvements in patient eligibility verification set the foundation for your entire billing process. This week’s post explores enhancing two key components in the claim submission process to ensure you’re submitting clean claims on time.
In the time between welcoming your patient for treatment and submitting their claim for payment, there’s vast room for error. Errors that lead to rejected or denied claims - like using the wrong ICD-10 code, invalid patient data, or incorrect dates of service. To handle claims submission, many providers turn to a clearinghouse that electronically scrubs the claim for errors, allowing providers to submit clean claims to payers on the first attempt.
Scrubbing optimizes the chances of quick and accurate reimbursement while dramatically reducing your labor costs by lowering the number of times you touch each claim.
Advanced clinical scrubbing further safeguards your claims by improving accuracy across thousands of coding and billing requirements, focusing on correct diagnosis and procedure codes. Most clearinghouses provide some basic clinical scrubbing, but superior clearinghouses should provide advanced clinical scrubbing.
Monitoring Timely Filing
The old saying “better late than never” doesn’t apply to claims submission. Late claims will result in denials and lost revenue.
Keeping track of multiple payers with different filing deadlines and guidelines can make your head spin. Managing timely filing of a re-billed claim is also vital.
A clearinghouse partner that tracks timely filing of your claims will prove to be a huge asset to your organization. Timely filing reports alert you to billed or re-billed claims in danger of being outside of timely filing guidelines. These features also allow you to easily spot any internal workflow and training errors preventing your claims from being filed on time.
Not all clearinghouses are created equal.
A truly advanced clearinghouse will provide features and benefits that go well beyond the traditional clearinghouse services. For instance, automated reporting and analysis of your claim adjudication data is tremendously beneficial to your organization. Look for a clearinghouse partner offering advanced claim edits, functionality and reporting capabilities. When choosing the right clearinghouse, it’s essential to evaluate their payer network and the number of direct connections they maintain. Clearinghouses supporting a strong network of direct connections helps ensure claims reach the payers in a timely manner. You should also seek a clearinghouse solution that provides for cohesive integration with your other IT applications.
If you’re not using a clearinghouse, you’re missing the opportunity to streamline your workflow, touch claims less, reduce denials and rejections and get paid faster.
Next week, in the final post of our Bill Well and Prosper blog series, we’ll examine how reporting and robust business intelligence is fundamental to effective claims management and a thriving business.