Filing insurance claims electronically can reduce payment time to 10–14 days, on average

Are you sure you are being paid by the insurance companies as fast as you should be?

Depending on who you talk to, the business of chiropractic is either getting more difficult or less difficult and it all seems to hinge on the same topic: financial reimbursement.

The other day, I had a conversation with my billing department employees and I asked them, “Do you remember when we used to mail out paper claims? Do you remember how long it took to process those claims? How many times did we have to resend those claims back to the insurance companies after they told us they never received them, that our billing information was incorrect, or that we had an incorrect address?”

Insurance companies have made it as difficult as possible for DCs to get paid; the insurance companies obviously have a strong interest in paying out as little money as they possibly can. It seems as though they all play the same game with us and that they have created an extremely difficult set of hoops that DCs have to jump through to file and collect their insurance claims.

Filing insurance claims is very expensive for a DC’s office to perform. It is also extremely time-consuming and often very frustrating. On top of that, if any small detail on the paperwork is not filled out correctly, the insurance company will reject the claim and send it back to the DC unpaid. The DC’s insurance department will then try to figure out what the problem is, correct it, and then resubmit the paperwork, hoping they got it right the second time around.

I’ve heard that on average, 35% of claims are rejected by insurance companies. Other claims get lost, which increases the average time it takes for the DC’s office to be reimbursed to between 45 and 60 days. I don’t know about you, but for my office, that is entirely too long.

Billing insanity! This is the method of using the old-fashioned way of billing and expecting the insurance company to change its habits when you haven’t changed yours.

Today’s insurance companies work entirely through computer software. When used properly, this software speeds up reimbursement time for claims, and will decrease the amount of work your staff goes through to get reimbursed. This, in essence, will reduce your overhead by reducing the amount of time your staff needs to spend on each claim.

The Solution: Electronic Medical Claims Submission
If you are interested in cutting the time your office is reimbursed by the insurance company down to 10–14 days on average, then keep reading.

Here’s how it works.

Most of today’s chiropractic office software has the capacity to file claims electronically. All you have to do is ask your software company to walk you through this simple, step-by-step process.

Next, you need to find a national claims clearinghouse, which is the middle man in this process. If you are not sure how to go about this, call your state chiropractic association, or ask the software company that you are currently using to recommend one.

The clearinghouse is a place where you will send an electronic file of all your claims. It will check your claim to see if any billing errors will prevent it from being processed by the insurance company. If it has billing errors, the clearing- house will notify you via e-mail typically within 48 hours, and will show you exactly what to fix. After fixing these errors, your staff will resubmit the claim to the clearinghouse with a push of a button. The clearinghouse will then forward your claims to the insurance carrier.

Now all you have to do is sit back and smile. It’s that easy.

Benefits of Electronic Claims Submission
1) Faster reimbursement. Electronic filing dramatically reduces the amount of time it takes to collect from the insurance company. Instead of taking months, it takes anywhere from 7 to 21 days.

2) Lower rejection rate. The rejection rate for claims dramatically reduces from 35% to approximately 5%. Now, your staff will almost instantly know how to correct a claim because the clearinghouse does the work for you.

3) No more lost claims. It’s kind of hard for the insurance company to say it lost your claim when the claim was sent by an electronic file. You have a record of it, and so does the insurance company.

4) Saves staff time. After implementing electronic billing, you may be able to eliminate unnecessary staff or you can use their time more wisely for other areas of your practice that may be lacking. If you are actually involved with the billing of claims, you will be able to leave this to your staff so you can focus on the most important parts of your practice: your patients and your marketing.

5) Eliminate practice stress. Now that your billing department is working effectively and efficiently, you may be able to actually take some occasional time off.

Moving your practice to electronic medical billing will help you take more control of the practice and your financial future.

Using Your Current Software for Electronic Billing
When your billing department is ready to bill the claim to the insurance company, your software usually gives you the option of creating a claims image file or a paper claim. Now, rather than creating a paper claim, your billing department creates a claims image file, which is a snapshot picture of your insurance claim that is saved into an electronic file. This image file needs to be named and dated for future reference.

For example: Image File 1/25/2006 morning claims #1
All this means is that on January 25, 2006, your billing department sent out one set of claims in the morning. If the department had sent out a second set of claims in the morning, you would name it Image File 1/25/2006, morning claims #2.

Your billing department employees will determine a simple way of naming the electronic file that is sent so they can recognize it when it comes back with errors that need to be corrected.

This image file is now sent to the clearinghouse. The clearing-house will have a Web site where your office will log on, and within minutes after you send your electronic image file, you will be able to see if any of the claims you have just sent have errors. Your office will automatically receive a claims report stating whether or not the claims were rejected or not. If everything is OK, the clearinghouse will forward your electronic file to the insurance carriers. The insurance carrier will then send a report back to the clearinghouse accepting or rejecting the claims.

More errors are generally found through electronic claim submission than through paper claims, because the clearinghouse software will automatically kick out the claims that are not correct, whereas sometimes paper claims can have errors and still get through. CP

Michael Wax, DC, operates four practices in Georgia. Contact him at michaelwax@bellsouth.net.