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Medical Billing Clearinghouse: Electronic Health Record Use Adopted by an Increasing Number of Practices

Close up of mature male doctor using digital tablet

Physicians and healthcare providers are continuing to invest in the use of medical claims software systems. According to a survey conducted by the consulting firm Software Advice, they are doing so to increase efficiency for medical staff and for their patients. The survey found that 35 percent medical claims software users indicated that they are investing greater amounts in their systems than in previous years.

One major reason is the desire for mobile access to patient information. Medical billing software partners are able to keep up with technology and provide patient portals for prescribing medication, managing lab results, and communication. While many still access data from a desktop computer, it is possible to access information from laptops, tablets, smartphones, and other portable devices.

In addition to the improved access to patient information, the medical records are more easily read. Legible patient data is a simple way to prevent common errors in claims submissions. Even a misspelled patient name can cause a claim to be rejected, costing several weeks or months to make the correction. This means you receive payments from the insurance companies faster.   

Apex EDI is the fastest growing electronic medical claims partner in the healthcare industry. Our software solution is unique because it will work with virtually any practice management software. We offer superior customer support and the most complete range of features and capabilities in the technology. Interested? Well we have the perfect thing for you! Contact us today to watch a free demonstration of our medical billing software.

Posted in: Medical Billing Clearinghouse

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Medical Billing Clearinghouse: What Can I Gain by Using Billing Software? What Can I Lose If I Don’t Use It?

closeup of a stethoscope on a laptop

Most healthcare providers spend years learning how to build a successful medical practice and focus on providing top notch patient care. Yet, sometimes ignored, medical claims, is an extremely important component of your business. Billing challenges can slowly drain your financial outcomes and become a serious distraction for office staff.

The business side of your healthcare practice can be improved substantially with the implementation of a medical claims software. Working with a billing partner allows you to remain focused on patient care, while they handle the burden of worrying about insurance companies rules and constantly changing coding standards. It’s a cost effective way to ensure your claims are paid in a timely manner without the hassle.

The addition of a highly trained customer support team through a medical billing partner also saves money that you would spend on the ongoing education of your staff. The healthcare industry as a whole is changing. You’ll gain the security of knowing you can rely on an experienced, trusted team of representatives to ensure your billing practices are current.   

Even the smallest mistake on a claim submitted can cause an insurance company to reject the claim. Your practice loses time and productivity while your staff works to correct, resubmit, and wait for claims to be accepted by the insurance payer. This process can take several months before you receive payment.

Apex EDI wants to help you remain current with the industry’s easiest and most cost-effective medical billing solution. Contact Apex EDI to watch a free demonstration of our billing software today.

Posted in: Medical Billing Clearinghouse

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Claims Processing: Could My Claims Be Returned by the Insurance Company? Why?

Health Insurance Denied Form Showing Unsuccessful Medical Application

Claims can be returned for a variety of reasons. The most common cause for a rejected claim is missing or inaccurate information. For example, errors in patient data such as the date of birth, age, sex, address, or name will cause an immediate return. Then there is provider information and insurance identification numbers, which can be easily and unintentionally misrepresented.

When the insurance company payer receives a claim, they check to make certain the patient is covered by the policy and all treatment codes match the appropriate diagnosis. Sometimes preauthorization records, referring physician identification numbers, or evidence of medical necessity is left incomplete.

The use of a medical claims processing software ensures all required information is included in the claim, prior to submission to the insurance payer. The software will catch any obvious errors such as missing or invalid information easily. The best way to increase claim payments is through prevention, submitting a clean claim the first time without any errors.

A medical billing software solution is well worth your investment. Apex EDI wants to simplify claims processing for you, so you can get paid faster. Contact Apex EDI to watch a free demonstration of our software today.

Posted in: Claims Processing

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Claims Processing: What is Claims Adjudication?

After a medical claim is submitted, the insurance company determines their financial responsibility for the payment to the provider. This process is referred to as claims adjudication. The insurance company can decide to pay the claim in full, deny the claim, or to reduce the amount paid to the provider.

When an insurance companyAdobeStock_94630507 decides to reduce a payment to the provider, they have determined that the billed service level isn’t appropriate for the diagnosis or procedure codes. Therefore, it is important to ensure that all claims submitted for payment are coded accurately.

As soon as an insurance company receives a medical claim, they begin a thorough review. Sometimes even small errors such as a misspelled patient name may cause a claim to be rejected. This delay prevents you from receiving payment while corrections are made.

When claims are submitted electronically, the software can help prevent errors such as incomplete or inaccurate information before it is submitted for payment. This helps increase the speed at which you can be reimbursed for services.

Once claims are received by the insurance company, the review continues with detailed analysis of the insurance policy. Some claims are even checked manually by medical examiners who examine medical documentation to determine if procedures are medically necessary.

When the claim has passed through the review process, it can finally be paid. Having a claims processing partner, like Apex EDI, to prevent errors in claim submissions helps you get paid quickly. Contact Apex EDI to watch a free demonstration of our software today.

Posted in: Claims Processing

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Medical Claims: What Does the Medical Claims Process Look Like?

The medical claims process begins when the patient goes to the healthcare provider for any service, from refilling a prescription to major surgery. The patient is responsible for paying the insurance deductible after the visit and providing insurance information to the healthcare provider.

Health insurance claim form with glasses

Typically, front office staff begin the claims process with a pre-registration form. Information such as patient name, birth date, and insurance policy number is gathered. Keeping current medical records helps expedite the billing and patient check in process. It can also eliminate errors that may occur. For example, if the patient forgets to bring insurance information with them.

Once the patient provides insurance information, the office must confirm the medical services that are covered under the patient’s insurance policy and what medical conditions the insurance provider requires in order to justify financial payment.

When the patient receives service, it is important for the provider to record all medical services received. To bill the insurance company, each service must be coded accurately. The bill must also be compliant with legal requirements set forth in the Health Insurance Portability and Accountability Act (HIPAA).

It’s imperative to confirm that fees are charged accurately and that every code submitted is billable before it is sent to the insurance company. This insurance medical claim provides the payer with important information about the diagnosis, procedures, and the charges. An accurate insurance claim ensures that you are reimbursed in a timely manner.  

Apex EDI acts as a clearinghouse and liaison between healthcare providers and insurers. We can help format claims and submit the medical claim to the insurance company. Accurate, timely claims help you get paid faster. Interested in our help? Contact us, at Apex EDI, to watch a free demonstration of our medical claims software today.

Posted in: Medical Claims

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