Despite increased out of pocket expenses for patients and practices testing direct pay models, most practices still get at least 65% of their revenue from payers. The process of submitting claims and getting paid has always been fraught with errors. To combat this, most payers now accept—and some mandate—electronic submission. Most practices have had some form of billing software as well. Despite these steps, they still struggle to get paid in a timely manner.
Some of the problem lies with payers, but there are best practices that can help you get paid faster. Your practice management system might already offer some of the tools you need.
By implementing some or all of these suggestions, you can get your practice's medical claims submitted and paid much faster.
The goal should be to get claims submitted in three days or less from the time of service and then track them through payment. Ideally, if everything is in order you should be able to achieve average days in A/R of 40 days or less and have a net collection rate of 96%.
- Capture charges electronically: You can do this with an EHR or with an electronic charge capture solution. Sending claims to the billing system electronically has many benefits in addition to being faster. By using electronic charge capture, you can also reduce coding errors, help prevent over and under coding, and improve accuracy.
- Submit claims the day the superbill is received: By using an electronic superbill, there is less data entry for billing staff. So once the superbill is received it should be much faster and easier to submit.
- Scrub all claims: Your billing and practice management system should scrub claims for you before submission to let you know if there are problems. Your clearinghouse will do the same. You can generally fix these problems and resubmit. With these two checkpoints, you should be able to submit a high percentage of clean claims.
- Monitor claims after submission: Once your claims have been submitted to your payers, you want to watch for any problems and address them quickly. Your ERAs will provide information about what is paid—or not. But there may also be claims that slip through the cracks. Use a no response trigger to alert you to potential problems with those claims. No response allows you to set parameters for payers. For example, if BC/BS always pays in 21 days or less then set the no response alert to let you know if claims aren’t processed in 22 days. Then, you can follow up to see what the problem is.
The combination of process and technology can help you submit claims sooner and cleaner while also helping you monitor for problems. If your practice management and billing system doesn’t offer the tools to support this process, then it might be time to consider a change.
If you are looking for more places where you can look to improve your medical billing, use this Billing Best Practice Checklist to see industry standards and establish goals.