One of the most significant traits of claims processing is how fast it can all happen. If a claim is processed quickly it can be less expensive and your customer satisfaction will skyrocket. Find out why speed is so important and how to make sure you don’t lose a second when it comes to receiving payment.

The Claims Process

It should be so simple. Your practice provides a patient with treatment. They give you their insurance information. You supply the insurance company with a request for payment. It seems reasonable that they should process and approve your claim. However, each part of the process is governed by a number of steps and protocols that make medical billing increasingly complex.

When physicians provide services, they write down or input what took place. Medical coders record ICD codes that indicate the patient’s diagnosis and CPT codes that relate to treatment. They use these codes to create a summary, then add patient, provider and insurance information before they submit the claim.

Medical billing specialists rely on computer software for inputting and submitting information. The HIPAA Transactions and Code Set Rule sets standards for software used in creating claims, but healthcare providers and insurance companies can all use different programs as long as they follow the standards. There’s no consistency, which creates confusion and discrepancies.

In addition, providers can submit claims to insurance companies on paper or electronically. While electronic claims are easier to process, resulting in faster turnaround times, some providers still prefer paper.

Why Speedy Processing Matters

The process of receiving reimbursement for services has gotten so lengthy and complex many providers have just accepted delays as a necessary evil. Staff may assume if the patient has coverage, as long as they eventually receive payment, there’s no need to hurry the procedure. A Healthcare Business and Technology article on medical claims processing says processing delays due to errors cost providers an estimated $125 billion every year.

Errors sometimes go undetected until providers submit a claim. When claims are rejected or denied, the appeals process takes time. Consider the following:

• The American Medical Association (AMA) says claims that are rejected, underpaid, denied or in need of resubmission cost individual practices as much as $100,000 a month.
• Since many practices don’t resubmit claims, they often miss out on thousands of dollars a year.
• Claims aren’t always denied due to medical biller or healthcare provider error. Another AMA study says almost 20 percent of the time, insurers are the ones who make processing mistakes.

The longer it takes to submit your claim, the more time elapses between when you provide services and when the insurance company starts to process information. Often patients are responsible for a portion of their bill, and providers don’t know what that amount is until insurance has finished with the claim. If correction and resubmission is necessary, it delays patient billing.

Delays and resubmissions increase processing cost. When providers have to pay staff to correct claims, they pay higher overhead.

Patients have seen increases in both deductibles and out of pocket expenses in the last several years, making medical bills harder and harder to pay. A TransUnion study states patients saw an average of 13 percent higher costs since 2014. While many patients budget for medical expenses, the longer it is before they receive a bill, the less likely they are to submit payment.

How Manual Claims Slow Processing

The slowest way to receive payment is to fill out paperwork by hand and mail it in to an insurance agency. This method creates multiple opportunities for error. When a person fills out the claim, it’s easy to transpose numbers, misspell names and omit necessary data. Forms can get lost in the mail or sent to the wrong department. Once they reach the insurance agency, someone from the payer must input information into their system, creating another opportunity for error. The provider loses time while claims go through the mail and the payer inputs information.

Electronic Claims Are Processed Faster

When claims are filed electronically, they have improved accuracy and are processed more quickly. Claims processing software often won’t allow coders to submit bills without completing necessary information, reducing the number of claims rejected for blank fields.

Electronic forms prevent the errors that come with paper claims because print is always legible. Software also often includes scrubbing tools that check for common mistakes.

Healthcare providers also use optical character recognition (OCR) equipment to input information and create electronic claims. The equipment scans information from documents and inserts it into the correct claim field. OCR isn’t foolproof, and if it records digits or patient information in the wrong place, a human must intervene to correct mistakes.

Other Reasons Speed Matters

Healthcare providers are becoming increasingly competitive, and physicians can’t afford to lose revenue. Faster processing reduces costs and cuts the potential for fraud while keeping patients happy in these ways:

Improve customer satisfaction – Patients pay a lot for their insurance coverage. When there’s a problem or delay with their claim, it causes stress. Speedy processing doesn’t just cut provider expenses, it improves doctor-patient relationships.

Avoid litigation – When patients have a legitimate claim and can prove coverage, insurance companies will eventually pay. When delays result from coding errors or incorrectly submitted bills, the insurance company and patient experience increase dissatisfaction. Medical billing errors like undercoding and upcoding are against the law. Claim disputes expose physicians to potential litigation.

How a Medical Billing Clearinghouse Helps

Thousands of medical practices rely on Apex EDI to get paid quickly because our medical claims processing software prevents errors and eliminates delays. We allow providers to send claims electronically and receive up-to- the-minute verification of patient benefits with one easy-to-use desktop application. We capture claim files from your existing software and transfer it directly to payers, scrubbing it for errors as it transfers. Simplify claims processing and get paid fast when you schedule a live demonstration today.

smallbusiness.chron.com/importance-claims-management-insurance-sector-41811.html
www.claimsjournal.com/news/national/2009/01/14/96972.htm
www.medicalbillingandcodingonline.com/medical-billing-claims-process/
www.medscape.com/viewarticle/745041