Wednesday, April 30, 2008

Q. What is the most efficient way to file claims electronically?

A. There are two "buckets" to consider regarding electronic claims: Medicare; and Medicaid/commercial payers.
Last year, CMS mandated that all claims must be submitted electronically. Today, most providers manually "batch" claims and then monitor the send process to ensure their dial-up modem line doesn't drop their submittal. They then must re-visit CMS's systems frequently to check/view remittance information, but there's no easy way to associate the ERN data with the specific claims files that were sent.
The most efficient way to file Medicare claims is via an Internet-based system that uses File Transfer Protocol, eliminating both manual claims batching and the need for dial-up modems. The system should automatically file claims once a sales order is confirmed and automatically tie ERN data back to individual claims. A system with this approach promptly "alerts" billers of denials and other claim-specific information, which further automates workflow. This solution dramatically increases billing efficiency while decreasing DSO and eliminating the need for hardware.
Medicaid and commercial payers
Providers can opt to file electronically by logging on directly to each payer's Web site. While this is faster and more efficient than paper-based billing, it is not ideal. Billers must learn how to navigate multiple Web sites and re-key data in multiple places, increasing error rates. Some providers choose to contract directly with a clearinghouse, which aggregates connections to hundreds of payers and provides billers with a single Internet interface. However, this system also poses usability, tracking and support challenges.
The most effective solution is a Web-based billing system that delivers an FTP connection to payers. These billing systems provide one unified interface, better pre-editing of claims, automated batching, robust tracking and status, and end-to-end customer support.
Bottom line: The more automation and integration with other systems that you achieve, the better your return on investment. HME