February 13, 2014
Organized healthcare for masses is based on the sturdy system of medical insurance and patient coverage. Over the past decade, healthcare reforms have resulted in efficient processes and better medical methodologies. Therefore, billing and claim filing have also become increasingly automated and effective. While primary healthcare practitioners have internalized electronic claim filing to a great extent, specialty care providers have still refrained from adopting electronic claim filing due to fear of increased costs and complications. Your Gastroenterology practice can, however, gain exponentially in terms of process productivity and revenue cycle management with adoption of e-claim filing.
To file claims electronically, your billing team or medical staff must be able to pay attention to the following details –
Medical data record – In order to file electronic claim, it is imperative that your patient records are maintained electronically for easy access and transfer. In addition to that, billing and coding formats should be standardized to avoid any redundancy of medical records. Electronic claim filing is usually a highly efficient and time saving process. But in order to avoid any complications in the event of a claim denial, it is better to maintain paper records of all your billing transactions and services provided as well.
HIPAA compliance – The Health Insurance Portability and Accountability Act of 1996 has established some relevant standards and formats to file electronic claims. E-transfer of medical data pertaining to patient records is a highly sensitive matter with various data security issues related to it. To ensure complete data security and consistency, your electronic claim documents must be in compliance with HIPAA guidelines. Therefore, review of all documents prior to filing for claim is of utmost importance.
Clearinghouse charges – While most medical coding and billing service providers do not charge additionally for filing claims electronically, clearinghouses have inbuilt charges for the different claim filing and processing stages. Clearinghouses are the intermediaries which in turn accept and process claims on behalf of government and private insurers. Most GE practitioners are unable to identify these service charges of clearinghouses for electronic claim filing and therefore hesitate in adopting e-claim filing completely. Even when you outsource the entire billing and claim filing process, you must be aware of the clearinghouse that your billing service provider is tied up with and what is the exact cost of filing e-claims.
Follow up dates and Turn-around-time – Filing your medical claims electronically provide your GE practice the luxury of tracking your claim process more transparently. Your medical staff should be trained to track the claim status online and record actual turn-around-time for better revenue cycle management. It is also important to refrain from re-filing of electronic claim in the event of no physical documentation to confirm claim acceptance as duplication of claim can lead to claim rejection.
Medicalbillersandcoders.com offers specialty specific billing and claim filing services with the help of its team of medical experts who understand the nuances of claim filing process. We offer your gastroenterology practice a complete claim settlement solution that maintains documentation, file claim as per standard formats, ensure compliance and minimize your clearinghouse charges.
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