Streamlining Insurance Collections With HIPAA Electronic Transactions

The primary way to increase revenue and cash flow is to reduce the time it takes to collect payments. HIPAA electronic transactions can greatly streamline the insurance collection process.

Electronic Submission (837 Professional & Institutional) versus US Mail. It is common to submit claims electronically, but it is important that you highlight the efficiency of electronic claims.

In the past, claims were sent to the payer by mail. The claim was mailed to the payer after it was received by the postal service. Once the mail arrived, the claims were sent to the payer. There they were sorted and distributed among the employees responsible for approving the claim. Each paper claim was manually reviewed for any errors or incomplete information. It could take several weeks for the time to complete.

Electronic filing allows you to send your file directly the payer or to a clearinghouse. The claims are reviewed by the payer’s computer system for missing information and unmatched subscribers. Online access to the status of your claims is possible. The claim status can be viewed online with a good practice management system. If errors are found, they will be immediately worklisted for further investigation. It takes just a few days to review a claim and correct any errors.

Electronic Status Requests and Reactions

Days go by and no payments are received. Before electronic status requests were available, your staff would need to call the payer to check the status of the claim. This type of follow-up can take up to an hour and is not worth the time spent waiting on the phone.

You can send an electronic status request to get an instant response. If the claim was not received by the payer, it will be reviewed and paid. It takes only seconds to check the status of a claim.

A good practice management system will be able send electronic status requests automatically to have the response posted. This would further enhance the process. The practice management system can also interpret the response and make a decision to add the matter to a worklist for manual follow-up. If a payment has been made, or the claim is still being processed, it can wait to make a decision. If there is a problem or denial, it can immediately worklist. The practice management system can also automatically submit the claim again if the payer indicates that they have not received it. The system handles all routine payer calls so there is no need to waste time on them.

ERA – Electronic Remittance Advises

The claim has been paid and a paper copy of the remittance advice sent. After the remittance advice has been reviewed and interpreted, payment can be posted. The balancing process can be slow and time-consuming.

Electronic remittance instructions (ERA) allow you to have the payments posted automatically by your practice management software. This allows you to spend less time on partial payments or denials, and can start patient collection sooner. You can reduce the time it takes to post remittance instructions from hours to minutes.

Good practice management systems will allow you to review the ERA payment before posting. It automates the process by automatically registering denials or partial payments. The system will automatically release any secondary claims that have not been paid and track them for payment. A good practice management system automates the workflow, tracking and payment of claims. This saves you more time.

Electronic Attachments

Attachments are a problem that slow down the process and prevent the claim from being sent electronically to the payer. Good news is that payers are beginning to recognize this problem and will now support electronic attachments.

If the payer requests an attachment, you must print the claim and attach it. You will be penalized for filing paper claims and you will receive a significantly longer payment time. Although you can send your claims electronically, it is not possible to fax the attachment. However, the attachment may reach the person who reviewed your claim. You can also send the claim electronically, and wait for the payer’s request to attach the attachment. The process can be slowed down by attaching documents. This can take up to weeks.

You can scan your document, and then send it electronically via electronic attachments to a clearinghouse which will send the attachment to the payer. These clearinghouses assign document IDs to each attachment. This allows the claim to be electronically linked to the attachment. The attachment can be opened by the payers who are reviewing the claim. Some payers will only accept attachments that have been requested, while others may accept attachments along with the claim. The time it takes to process a claim can be cut down by having an attachment sent along with it.

A good practice management software will automate attachments. It will also streamline workflow by searching for scanned attachments, and automatically filing the claim with the attachment if it is found. It will also worklist any claims that have an attachment that has not been scanned or is not yet ready. An effective practice management system automates attachment processing, further reducing time for the biller to manage attachments.

Electronic transactions can improve your profitability by reducing your labor costs, streamlining the process, managing your insurance claims and improving cash flow. These benefits can be enhanced by a good practice management system that manages the workflow.