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Why You Need to Secure Your Claims Processing

Why You Need to Secure Your Claims Processing

Health insurance has been a highly debated topic over the past few years. With the Affordable Care Act, we have more insured Americans than ever before. 

With more people using various forms of health insurance, we also have more insurance claims to file. This often means that medical associations and individual practitioners are getting slammed with more and more paperwork. Medical billing can be overwhelming.

Medical claims processing can be a stressful ordeal, so let us help you figure out what you need to know.

How medical claims processing works

We live in a world where technology is expanding at unbelievable rates. With this massive growth, the way we do things is constantly changing. What was commonplace even a few years ago may be obsolete now.

The medical field is no different. While we all know that medical procedures have changed drastically over the past decade, many people don’t consider how much the work behind the scenes has changed.

Whether you have been in the field for years or are just starting, we’ll show you what you need to know.

The old way

Let’s start by looking at the traditional process of medical claims processing. We’ll paint the picture. 

It’s a Tuesday morning and you’re still working on claims from last week. You have a pile of files on your desk. They are medical claims that need to be filed with several insurance companies.

They are sorted into distinct piles based on where they should be submitted. It’s a lot to keep track of. You diligently fill out the forms. After a few hours, you can feel that familiar tension building between your eyebrows.

Now that you’ve started to make a dent in your first pile, it’s time to start correcting the older, rejected claims.

The first few go quickly. Silly mistakes, typos, and an incorrectly spelt name. You can’t believe you missed these the first time, but at least they’re easy to fix.

Suddenly, you get stuck on one. You can’t see anything wrong with the form and you’re not sure why they denied it.

You glance at your phone, then decide to set the file aside so you can deal with it later. You have too much to do to spend a half-hour on the phone with an insurance company right now.

By the end of the day, you’re even more behind than you were this morning. Then you see that file next to you. You forgot about it. So you call the insurance company.

20 minutes later, you still aren’t sure what went wrong, so you put down the phone.

If this sounds familiar, rest assured that there is an easier way. 

The new way

Now imagine it’s Friday and you aren’t behind at all. You started using a clearinghouse for your medical claims processing. The process seemed so different at first, but you’ve gotten used to it and now it feels like second nature.

You simply log into the clearinghouse and upload your files. After a few minutes, you notice that several were flagged, so you quickly go in and correct the problems. 

Then, the forms are sent to the insurance companies, so you don’t have to think about it much. 

In fact, you’re already getting reimbursed for claims filed a week ago!

You can do more claims quickly and you know that it’s secure and HIPPA compliant. You finally feel at ease.

Benefits of using a clearinghouse

The new way of medical claims processing simplified life for those of us who do regular billing.

Whether you’re an individual with a private practice or the head of a medical claims processing department that bills for many healthcare processionals, a clearinghouse can help you.

But a more enjoyable workday isn’t the only benefit of a clearinghouse. In fact, we have a list of ways this service can help you!

Fewer problems

Using a clearinghouse for your billing can drastically reduce the number of errors in your claims. In fact, the average error rate for claims submitted electronically through a clearinghouse is 25% lower than those submitted by paper.

Make changes quickly

When you do have an error that the clearinghouse catches, you can correct it quickly. Before it is submitted to the insurance company. This means that you are fixing the problem in a matter of minutes, rather than weeks.

An extra set of eyes

Since the clearinghouse catches so many little mistakes, you can trust that you’ll have fewer claims denied. It’s nice to have someone looking out for you! 

Batches of claims

Since clearinghouses do medical claims processing for a number of insurance companies, you don’t have to sort them on your own like you did when you submitted claims to each company separately. Instead, you can simply upload all of your claims at once.

Fewer headaches

For those moments when you do have trouble with something, you can be assured that you’ll have someone (other than the insurance company) to call for help. The customer services that goes along with a clearinghouse means you won’t have to figure out everything on your own.

Accurate picture of finances

Because the clearinghouse streamlines the process of medical claims processing, everything moves faster. Instead of waiting weeks or even months for an insurance company to reimburse you, you may only have a wait a few days. With less to keep track of, you’ll know where you stand financially on a more immediate basis.


You know that the clearinghouse uses HIPPA compliant procedure, so you don’t have to worry as much about potential violations.

Save money

Another important benefit of a medical claims processing service is the fact that it will save you money. Because of the streamlined process, fewer steps means you won’t need to spend as much time billing insurance companies.

With less time, you need as many people working on billing. A smaller staff means fewer expenses.

Next steps

Now that you’re ready to work with a clearing house for your medical claims processing needs, what’s next?

Choosing a reliable company is absolutely crucial when you’re dealing with sensitive medical information. Make sure you’re in the right hands.

We offer a free live demo of our software, so you’ll know exactly what you’re getting before you commit. If you have any questions, don’t hesitate to contact us.

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How Medical Claims Processing Software Lowers Costs

How Medical Claims Processing Software Lowers Costs

Medical claims processing can be a costly and time-consuming chore for today’s health-care and medical professionals. It’s a daunting task, but it must be done accurately and efficiently.

Here’s the good news — today’s medical claims processing software is easier to use and more effective than it ever has been.

The added bonus? It actually lowers costs.

Manual Claims Management Costs More

Organizations that are filing medical claims manually are spending $4 more per transaction! Depending on the size of the organization that really adds up quickly.

Once you factor in the cost of labor on top of that, the costs get even higher.

On the bright side, by switching over to a more automated, electronic medical claims management system,  the savings can happen almost immediately.

The medical and health industry simply can’t afford to do things the old fashioned way anymore. 

Cutting Costs With Medical Claims Processing Is Essential

In today’s market, it’s not just a good idea to cut costs wherever possible — it’s essential. It’s what’s necessary in order to stay competitive and stay in business.

If a doctor can’t provide efficient administrative solutions, they simply can’t do their job in the health and medical field effectively.

Especially with insurance policies changing constantly, control must be taken over every aspect that can be controlled.

Much of the cost comes from the administrative department. Every dollar that is spent in the claims process matters now more than ever.

Why Are There Providers Who Still Hold Out?

Just last year, HIMMS reported that a full 31% of all medical providers were still handling denied claims using manual processes. That’s a fairly decent chunk of the market that is losing money and time.

Why on earth would any of today’s providers resist the move over to automated medical claims processing?

They’re moving slowly and they’re shopping around essentially. The same report found that 60% of those who are still holding out a plan to switch over within about a year.

In the meantime, of course, they’re losing money, not to mention wasting a lot of time. They simply do not realize how much better their claims processing could be. 

Healthcare Providers Are Losing More Money Than They Think

The case for faster adoption over to automated medical claims processing isn’t just about the $4 per file. Manual processing comes with an even bigger price tag than many providers are realizing.

A healthcare payer looks at the auto-adjudication (AA) rate. This refers to the percentage of claims that automatically pass through the system with no human intervention. 

There are situations that have been reported where the cost of a human filing a claim surpassed the payout. If that happens enough times, you can only imagine how expensive that can get for everyone involved.

According to Pricewaterhouse Coopers, inefficient claims processing was the second biggest factor driving up medical costs overall back in 2009. The amount totaled a whopping $210 billion annually

Thankfully, better and better technology is available all the time. More healthcare professionals are adopting the latest software technology to streamline the process.

Most importantly, switching over saves money.

Costly Errors Are More Likely With Manual Processing

Many of these happen when entering inaccurate billing codes. When that happens, claims are less likely to get paid in a timely manner.

The chances that a human will make that error far surpass the errors that an electronic medical claims processing system can make. Even when information is electronically added to CMS-1500 and UB-04 paperwork, it’s still less likely that errors will occur.

However, it’s not the optimal automated process.

Electronic Medical Processing Has Come A Long Way

Electronic medical claims processing is definitely not new technology, but it’s changed a lot over the years. Optical Character Recognition (OCR) is an amazing advancement.

It decreases the chance that costly mistakes are made when coding and filing.

OCR scans documents, electronically isolates, and then records the information contained in the fields. It can also auto-fill information.

In this process, a human is still involved, but it’s to review the processing and ensure accuracy, not be solely responsible for it. If a medical code is not properly recorded, the error is reported by the specialist who is filing the claim.

This check and balance process saves time, money, and frustration for medical and dental professionals. It’s so effective that they simply cannot afford not to make the switch to this type of system.

Resubmitting Is Less Labor Intensive With Automatic Claims

Mistakes and coding errors happen when filing claims. It’s a reality in the medical profession, but that doesn’t mean that they have to take a long time to fix.

Not only can you catch errors faster with medical claims processing software, but they’re less likely to happen in the first place.

To correct an error on a piece of paperwork from an insurance company once it’s been submitted is a time-consuming process.

If you make an error with claims software, you have help at your disposal. Many medical claims processing software companies provide 24-hour assistance. There are also online resources available. 

An insurance company is not going to give anyone helpful call or talk to them in the middle of the night when a claim hasn’t used the right code. The error will simply not be remedied within a timely manner, especially by today’s standards.

Making The Switch Is Simpler Than You Think

It’s only a matter of time before the entire health and dental industry is taking advantage of automated medical claims processing. The reduced financial burden that using this system delivers makes it worth it.

More and more professionals are making the switch and they’re happy with the results. 

The key is to choose the right software company. There are better options all the time and not every company is the right fit.

They have to be able to be there through the switch every step of the way. 

With the right software solutions and support, switching to an electronic claim processing system doesn’t have to disrupt business.

Contact a company like Apex EDI to schedule a free, live, and personalized demonstration

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Medical Claims Processing: How the Right Medical Claims Processing Increases Profit

Medical Claims Processing: How the Right Medical Claims Processing Increases Profit

These days, more and more people seem to be noticing – and questioning – their doctor’s medical claims processing methods. But figuring out how your practice can cut down on medical billing errors is only a part of the process.  

When determining how to streamline the business side of your practice there is a lot to think about.

In this post, we’re going to clearly outline how the right medical claims processing can increase your bottom line.

It can even prevent your patients from challenging your medical bill.  

1. Make Sure You Know Each Insurance Policy’s Details

Your medical claims processing requirements will depend on the type of policy and the actual insurance companies of your patients. 

How are you bill these companies for reimbursement? Is it for operating costs, the expense of medical devices, or anything else?

All this, you know, depends on the claims submission process of the company. 

If you submit your claim incorrectly, you’re subject to slow repayment times. Sometimes, this means no payment at all. This leads to a lengthy appeal and resubmission process. 

To prevent this, we recommend researching individual policies prior to making a claim. You may even want to consider hiring someone to complete this process for you. The process can take around 6 hours every week to conduct the proper research. 

Additionally, look into webinars offered by Medicare and other policies to help keep you up to date. Always keep your finger on the pulse of policy changes. Even consider hiring a third party provider to help ensure you’re up to speed. 

2. Use Medical Claims Processing Software/Services To Improve Workflow

In a medical practice, the number of patients you’re able to see every day is directly tied to your profits. 

Using a medical claims processing service means your staff will be able to interact more with your patients. You’ll also get things done right the first time. Now, use office hours to focus on customer and patient satisfaction instead of filing claims and fixing problems. 

Especially in smaller practices, your staff is likely doing more than one job at once. Not only does this mean they’re more likely to make mistakes, it also leads to employee dissatisfaction. That can mean a high employee turnover rate. 

Getting the right claims services can help to make sure your employees are able to focus on the day-to-day operations of your actual practice, not the behind-the-scenes billing and filing work. 

This leaves both your patients and your staff satisfied.

3. The Right Claims System Cuts Down On Resubmitted Claims

It’s common sense. The fewer mistakes you make, the fewer resubmitted claims you have to file. That means you’ll be reimbursed and paid sooner. 

Look for professional billing and claims services that rely on experienced employees that focus only on the tasks of filing and fulfilling claims. You don’t always have the time or the resources to constantly train your own staff and keep up to date with the continuous policy changes. 

But a professional billing service will be up to date . That’s because that’s all they do. Look for services that also have 24-hour help lines or customer service representatives. Other DIY knowledge like forums and online resources where your employees can get basic questions answered the moment they arise. 

4. Look For An Analysis Of Your Claims Management

You’re always looking for ways you can save on time and costs in your practice, right? A good medical billing service can help. It can introduce you to options you weren’t even aware existed. 

They’ll scrutinize your current billing system and offer you ideas about how to improve your billin. They’ll also cut down on the mistakes you’re making.

Especially if you’re a newer practice, we know you’re eager to get things started off on the right foot. You might be concerned you don’t yet have the resources to do so. 

A good medical claims processing system and service acts as a cost-effective preventative measure that will help you ensure your business is streamlined. it will also keep it secure, and up to speed with current regulations. 

They’ll also help you to establish a plan for the growth of your practice, and make adjustments to your billing and claims processes as you expand. This way, you can spend your time focusing on how you plan to build your practice. 

5. Check That Your Billing Codes Are In Order

You likely already know that for every medical service or procedure you perform, there is a separate billing code. At least, there should be. 

Often, when practices are pushed for time or simply don’t understand the claims process, they’ll make the costly and careless mistake of assigning one billing code for an entire procedure. This can happen even if multiple, individually-coded operations or services were provided. 

This isn’t something your practice can afford to continue. It doesn’t matter what phase of business you’re in currently. 

And it’s not just the basic billing codes you need to make sure are correct. Each procedure also carries with it a 2-digit modifying code. For example, indicating which side of the body the operation was performed on.

If these aren’t included, you’re simply not providing the proper documentation to the provider. You’re likely going to miss opportunities for reimbursement. 

If this sounds like a lot to handle, it’s because it is. So why are you leaving it up to your already overworked staff? 

Instead, look into working with a medical claims processing service or software provider. They can make sure that you’ve submitted the correct claims to insurance companies – every time. 

Don’t Make One More Costly Mistake In Your Practice

By now, you can clearly see all the ways that the right medical claims software and practice can save you money, time, and even stress. 

There is no reason to continue losing money when the solution is so clear, and so available to you no matter the size or specialization of your practice. 

Want to leans more about where to find the best claim services, make sure you’re up to date with current policy changes, or to simply have specific questions answered? Spend some time on our website to learn about your options. 

Feel free to contact us to learn more about how we can help both your practice and your patients. 

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Medical Claims Processing: How to Pick the Best Medical Claims Processing Software

Medical Claims Processing: How to Pick the Best Medical Claims Processing Software

By the year 2024, nearly $1 out of every $5 will be spent on healthcare in the United States. If you’re a healthcare professional or part of a medical association, you’ve likely struggled with the most effective way to handle your billing.

You’ve also wondered how to grow your business. 

The right medical claims processing software can help to streamline every aspect of your business. How do you know if you’re selecting the right option? 

Here, we’re sharing with you the top 5 things your medical claims processing software should be able to do for you.

1. Meet The Needs Of Specialty Practices

83% of adults have met with some kind of a healthcare professional within the past year. Of course, how to properly handle the billing, payment, and claims of these visits feels like a full-time job.

If you’re a specialty practice or office, these claims can often get even harder.

The right medical claims processing software needs to be flexible.

It also needs to offer customizable options that best fit with the operations and services of your practice. It needs to have the kinds of templates, options, and tools that save your employees time.

Let’s say you work in workplace risk/health management.

Can your software optimize travel authorizations, recall schedules, and also send out automated replies and notifications? 

Is your staff is spending several hours each week tailoring the software to fit their needs? If so, it’s not a good use of company time.

2. Make The Case For Why Their Company Is The Best Option

Your patients aren’t coming to you because your practice or organization was the first name they stumbled across in their phonebooks. They’re coming to you because you offer unique, specialized, and great services that your competitors or other nearby practices don’t. 

The same should go for your medical claims processing software. 

Make sure the options you’re considering are CMS-approved.

Also make sure they’re  in accordance with compliance laws.

This means that their price point is fair, that they’re committed to patient and practice security, and that they have lots of references from clients.

Also, make sure your software can spot medical billing errors.

If they don’t, you might need to pursue other options. 

3. Get A Firm Count of Licensing Limits

You could be looking at the best medical claims processing software in the world. But if only two of your employees can actually use it, then is it really that great? 

When you’re trying to decide which software option to go with, make sure you’ve had a serious conversation with the company about licensing limits. This will not only make sure that you’re not hit with any surprising costs. It will also tell you about the kind of customer service you can expect to get from your software. 

Don’t get strung along. Ask right up front how many licenses (basically, how many people or devices in your office will be allowed to use the software) are included in the total price you’re being given. 

If you need additional licenses, look around at different costs before you say yes to a software company. 

Finally, be sure to ask if the license is a “one time only” activation fee, or if these licenses are going to be renewed every year. 

Unfortunately, this is an area where a lot of software companies can increase the price and sneak in a few hidden operational fees. Make sure your practice isn’t getting fooled by these business practices.

4. Provide Expert Security Options

Hacking happens now more than ever before.

What is your processing software doing to protect you and your patients? 

Especially if you’re considering using software that’s cloud-based, you need detailed, point-by-point answers to this question. 

How does our software plan to guard against cyber attacks and information theft? If it does happen, what’s their plan of action? 

Ask questions about how frequently they update and install things like patches and fixes, and what kind of anti-virus protection they currently use.

Always ask if the software provider has been faced with an attack before, and how they handled the past breach. There’s no such thing as being too cautious or too detailed when it comes to protecting the privacy of your patients. Same goes for your employees. 

5. Include Training For Your Employees 

We get it: medical claims processing software can be difficult to understand. But when yours comes with so many customizable options, or if you’re transferring tons of data from an old system or even paper, figuring out the process can feel totally overwhelming. 

That’s why, when you’re in the process of selecting your new software, you should look for a program that includes support and training for yourself. Also make sure it helps your immediate staff and your operation as a whole. 

Make sure that your software also comes with the option of self-service, so your employees can get questions answered and problems handled as soon as possible.

This should include things like 24-hour online support, continued access to educational options, and live tech support. 

Also look to see if there are training videos and tutorials hosted by the software. Also ask about brief how-to ebook guides or postings. There should also be forums where your employees can seek answers from other users or troubleshoot.

Finally, be sure that the software company you’ve decided to go with is willing and able to help you install and set up the software itself. 

You’ve Got All The Information You Need To Pick The Right Medical Claims Processing Software

When it comes to providing the best services for your patients, you don’t take the easy way out. The same should be said of your software. Do your research, ask a lot of questions, and look into several different options before deciding on your final answer. 

For more information about medical claims processing, to get your questions answered, or just to educate yourself a bit more on what the right software can do for your business, check out our website or get in touch with us today. 

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Medical Claims Processing: 5 Tricks to Easily Streamline Medical Claims Billing

Medical Claims Processing: 5 Tricks to Easily Streamline Medical Claims Billing

Is the medical claims billing process a painful one for your practice? It doesn’t have to be.

Taking a few simple steps to simplify medical claims billing can drastically improve your collections and even increase your practice revenue.

If you’re ready to make this process easier, check out the following 5 tricks below!

5 Tips to Streamline Medical Claims Billing

1. Take Inventory

First, take an inventory of where you are. This way, you can establish goals for, and periodically analyze, the progress and status of your accounts.

You’ll want to do a periodically analyze the progress and status of your accounts monthly or quarterly. Do this by tracking the following:

  1. Number of days in Accounts Receivable
  2. Percentage of net collections
  3. Aging of Accounts Receivable

With an idea of these stats in mind, you can then keep your eye out for ways to improve efficiency. This will then lead to increased and more timely collections.

2. Take Advantage of All Your Resources

There are plenty of resources and tools available to help you with your medical claims billing, so take advantage of them.

Give online tools, programs, and billing software a try. These can make a vast improvement in how effective you can bill. 

Instead of reinventing the wheel, make things easier for yourself and rely on these resources, which will have enough information to make your billing simpler.

An example of some awesome technology you can take advantage of as it relates to the collection process is an automated revenue management tool. Advantages of this tool include:

  • Automated payment reminder messages with convenient mobile or online payment options
  • Reduced amount of time you spend on sending out statements, trying to collect payments manually from patients, and also decreased billing costs
  • Integrated reports that will tell you how much revenue you are waiting on, and even how much revenue you have claimed. 

If you are struggling, however, experts are also available to help.

Medical billing companies can assist you by taking on the whole billing process for you. It doesn’t get much easier than that!

Also available are medical marketing companies, which can help you grow your practice. 

3. Use a Patient Portal

Have you implemented a patient portal into your practice management? If not, you’re missing out.

Using a patient portal can be a huge convenience to not only your practice but also your patients. Offering access to a patient portal will encourage your patients to take a more active role in their healthcare.

Benefits of using a patient portal could include the following:

  • Patients have the ability to view their complete account activity and submit payment information–all with the same security as online banking.
  • Your patients will have access to important documents. These documents could include digital x-rays or before-and-after shots, admittance forms, insurance documents, post-op care instructions, and any other documents you would like them to be able to view. 
  • By sending or receiving secure messages that can be archived to give you an added level of liability protection should the need arise, patients have the ability to communicate easily and efficiently with your practice. 

5. Create Policies and Procedures

Not only should you create policies and procedures for medical claims billing, but you should ensure that everyone on your team is aware of and familiar with them. 

To ensure a more cohesive understanding of expectations, discuss the guidelines and protocol regarding the process of collections with your team. Also, provide a manual for each staff member to use for quick reference. 

This will make it more likely that you will see an improvement in your revenue management over time. 

5. Be Informed 

Having an understanding of insurance coverage will help make medical claims billing easier.

Often, billers don’t know what is covered and what is not. This makes medical billing all the more difficult.

Understanding coverage will give you the ability to know how to bill for services better. Being informed about coverage will also allow you to understand who will be responsible–the insurance or the patient.

Checking eligibility may seem like a daunting task at first. However, understanding what’s covered and what isn’t covered is necessary for proper claim submission, as well as follow-up and patient billing. 

At the end of the day, being informed about and familiar with the different insurance companies your working with (including coverage policies, filing limits, coding edits, global policies, etc.) will make the medical claims billing process much less painful

Quick Tip: You should also keep a record of denial stats. This includes rates and reasons for denial and recurring denied claims in order to spot and prevent them in the future. 

Other Quick Tricks to Improve Your Medical Billing Collections This Year

  • Train staff to collect: Since collections begin at your front desk staff, it’s imperative that they are trained to get the cash before the patient is seen. 
  • Be transparent about pricing: Don’t leave your patients completely blindsided by costs that they have not budgeted for. This is one of the main reasons providers have a hard time with their medical billing collections, so to avoid this, be transparent about the expense.
  • Offer different payment options: Consider offering various payment options to patients who have to pay larger medical bills that they aren’t able to pay in full all at once.
  • Make paying easy: If you want your patients to pay their bills, you need to make the process as easy as possible. Online bill pay can be a huge help with this.
  • Incentivize your billing staff: First, you should recognize that it’s not a ton of fun for your billing staff to call patients day in and day out asking for collections on past-due accounts. Since this process can be frustrating and tiring, potentially leaving staff unmotivated, always show appreciation and offer an incentive program to keep them on track!

Which of these medical claims billing tips do you already use at your practice? Which tricks do you plan on implementing after reading those listed above?

Tell us how you plan on simplifying the process in the comments!

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