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Medical Electronic Billing
Medical Electronic Billing - Thru a
Clearinghouse or Going Direct Most people think that the only choice is
whether to bill on paper, or submit your claims electronically. Actually,
if you decide to file your claims electronically, that just opens the door
to many other decisions that must be made.
First of all, is your software capable of
electronic filing? If you are not sure you will need to check with your
software vendor to find out. Most likely if your software is capable of
handling the NPI number then it is capable of electronic filing.
Once you determine that your software is
capable you will need to decide if you are going to use a clearinghouse. A
clearinghouse takes all of your electronic claims and reroutes them to the
correct insurance carriers. All electronic claims would be batched
together into one file and then uploaded to the clearinghouse. Then you
would receive reports from the clearinghouse on the status of all the
claims you uploaded.
This method has its
advantages since you don't have to separate the claims, you just batch
them all together and submit them in one file. The clearinghouse usually
charges a per claim fee around $0.39 per claim. If you do a high volume of
claims, this can get quite costly.
Most
clearinghouses will also drop any claims that cannot be submitted
electronically to paper and mail them for you. Some offices like this
method because they can just batch ALL claims and send them to the
clearinghouse and be done with it. There is no printing, stuffing in
envelopes and mailing. Usually the drop to paper charge is a little higher
than the per claim fee for electronics.
Another method of medical electronic billing is to file them
directly to the insurance carrier yourself. You will need special software
for this in addition to your practice management system, but basically you
will be acting as your own clearinghouse. The software needed can be
costly, but you are eliminating the per claim fee. If you submit a high
volume of claims the cost may be worth it. As a billing service billing
for over 50 providers across the US, this option works well for us.
We are set up direct with our biggest
carriers, Medicare, Excellus, Medicaid and a couple others. Then the
remainder of claims go thru a company that acts as a clearinghouse.
Submitting direct to the insurance carriers can cut up to 3 days off the
processing time.
So once you determine
that you want to submit your claims electronically, you need to determine
which method will be best for your office. Make sure you research all your
options. Good Luck!
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Billing
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