According to the Spine Research Institute at Ohio State University, work-related musculoskeletal issues cost Americans up to $25 billion annually. Low back pain alone racks up as much as $78 billion indirect costs. Altogether, that’s more than $100 billion—a large portion of which is likely spent on chiropractic.
The question is: Are you efficiently and economically processing claims, so you collect the maximum amount owed? If not, you can change that by taking four simple steps.
Step 1: Apply Claims Processing Information to Your Patient’s Account
The first step to making claims processing easy is updating both patient and insurance information. At a minimum this would include:
- Patient’s name, address, phone number, date of birth, and gender.
- Patients insurance identification numbers.
- Insurance benefits like deductible amounts, coverage limits, copays and coinsurances.
- Insurance company’s name, address, and phone.
Step 2: Automates Insurance Charges
The second step involved in making claims processing simpler is to use a billing system that automates the charged portion of the billing process. What this means is you’ll automatically post how much the insurance company will reimburse for each service. Additionally, the system should automatically bill any copays or co-insurance, track when the deductible is met, and charge cash fees when benefits are exhausted.
Avery Partners, a company which provides medical outsourcing and staffing as well as home health and outpatient rehabilitation clinics, points out that there are many benefits of automating your business processes. These range from improved efficiency to greater reporting compliance to increased productivity, and even shorter collection cycles, meaning that you get paid quicker.
Step 3: Efficiently Manages Claims Posting
The third step to creating an easy-to-use claims process involves choosing a billing system that uses electronic remittance advice (ERA) for automatic claims posting. With ERA’s, all the user needs to do is upload a file and the billing software will automatically post any payments, write-offs, or patient charges for each claim. If your billing software is incapable of importing ERA’s, then the next best step is to post global transactions for each claim instead of posting to each line item. This function will significantly reduce the number of steps needed to process one claim.
In part 1 of do-it-yourself in-house insurance billing, we talked about the importance of using two monitors and a document management program. These tools make posting claims more efficient because you can view your scanned EOP’s on a monitor with the patient’s account open on the other. Now you can see and post payments easily without having to open and close windows or programs.
Step 4: Manage Your Unpaid Claims
The final step to managing claims is to track your unpaid claims. Know how to generate a 30, 60, and 90-day claims aging report in your billing system. These reports should show all unpaid claims, how many days past due, the patient’s identification information, and the insurance contact information. From here you can easily research these claims and make notes on the report related to the status of the claims.
Additionally, you should be familiar with your clearing house’s reports. There will be two reports to manage: the clearinghouse report and the payer report. The clearinghouse report will show their processed and rejected claims. The payer report will show the insurance carriers processed and rejected claims. The two reports tell you where the status of your claim between the time they’re submitted and when you receive the explanation of payment form. Processing your claims doesn’t have to be difficult. And it won’t be as long as you follow these four steps.
Finally, use a document management software that will index your scanned claims as searchable text. This way any missing claims can be instantly found by merely looking for the patient’s name or any other identifying information.