Billing Medical Claims Electronically

We have finally reached the stage where most offices are billing at least some of their medical claims electronically. But the more important question is, are they reading their electronic reports?

Just sending the claims in electronically is not enough. If you are not reading the electronic reports, then you are losing money. It is crucial to your practice that these reports are being read and being read regularly. If you say you don't have time to be checking the reports, then I say that you don't have time NOT to check the reports.

There is so much information on those reports that is necessary to keep your accounts receivable in check. I went into an office where the billing girl NEVER checked on electronic reports and NEVER did any followup. They were losing 33% of their receivables every single month! The doctors had no idea. The problem was she had too much to get done and that was what she put on the 'bottom of the pile' that she never got to. Unfortunately that meant that the doctor who owned the practice took a 33% pay cut without a choice.

The electronic reports tell you first and foremost if your entire batches of claims were received or not. Just because your file goes from your end doesn't mean it was received at the other end. Sometimes something as stupid as a "#" in an address can cause an entire batch of electronic claims to be rejected. If you are not checking your reports, that means that you don't get paid for the entire batch of claims due to one clerical error on one claim.

Sometimes your electronic batch will be accepted initially at the front end, but after the file is processed the batch gets deleted do to an error. You will receive a report if this happens. I recently had one provider's Medicare batches being denied because there was a discrepancy with the NPI number on the claims and the NPI number that Medicare had on file. The files were initially received ok but then the batches were deleted.

One of the other types of reports you will receive are specific payor reports. These will tell you if a patient's insurance is terminated, or if their date of birth is incorrect, etc. If you do not correct these issues, not only will you not get paid for that claim, but if the patient returns all the future claims will be denied as well.

You may not feel that you have the time to be checking these reports, but I hope that I have convinced you how important it is that you make the time. If your practice should be bringing in more money than it is and you are not checking your reports, that is most likely the reason.

Thanks
Michele