Electronic claim submissions are useful to cut costs and saves time as compared to manual claim submission. Instead, better spent with patients or focused on other practice efficiencies.

In today’s environment reimbursement continues to decline coupled with increased regulatory oversight hence it is necessary for physicians, patients, and the healthcare industry to be efficient. Hence getting paid promptly as well as accurately is a chief concern for many practitioners.

What are Electronic and Manual claim?

An “electronic claim" is a paperless patient claim form generated by computer software that is transmitted electronically over the telephone or computer connected to a health insurer or other third-party payer (payer) for processing and payment, while A “manual claim” is a paper claim form that refers to either the Centers for Medicare & Medicaid Services CMS-1500 form (formerly HCFA-1500) or a Uniform Billing UB-04 form. These both are typically sent to the payer through the mail and require postage.

After knowing both terms, we must understand what happens in each type of claim submission.

What happens in manual claim processing? It’s full of paperwork by hand and it will be shared with the insurance agency via mail. Due to manual process, chances of error are more. When a person fills out the claim, chances to misspell names and miss out on important data is more which leads to claim errors. Again from the payer side, when they input the shared data’s into their system, it creates another opportunity for errors which will slow the claim processing.

Electronic claims submission the claims are filed electronically which automatically reduces the chances of Claim errors and improves accuracy, so the claims are processed more quickly

Electronic claim submissions are useful to cut costs therefore it has been prompted by Medicare payment policies. This resulted in requiring hospitals and clinics to submit all Medicare claims electronically. Moreover, Physician practices may potentially realize increased practice efficiencies and savings in their practice’s claims revenue cycle.

Now, we must understand how Physician practices can realize several benefits from introducing electronic claims submission into the practice’s claims revenue cycle.

Benefits of Electronic claim submissions:

The important benefit of electronic claim submissions is saving time and cost. It reduces the amount of time as well as a need for resources to devote to a manual administrative function. Instead, this time can be better spent with patients or focused on other practice efficiencies.

Electronic claims submission can:

  • Pre-audit claim fields automatically for potential errors before submission to a payer
  • Detect claim issues and offer online claim resolution before processing by a payer
  • Submit claims almost instantaneously to a payer
  • Reduce postage, supplies, and mailing expenditures
  • With the help of an electronic audit trail claim's progress between intermediaries (e.g., billing service or clearinghouse) and a payer can be tracked)
  • Improve the practice’s accounts receivable

Reason for faster claim processing

Apart from various benefits of electronic claim submission, almost obsolete Paper claims are still used by certain payers. Billers will have to enter claim details in the forms provided by insurance companies and the complete details to send out paper claims. In contrast, electronic claims are created and sent to clearinghouses/insurers via their EHRs.

The introduction and use of HIT solutions are potential elimination of manual processes from the claims management cycle which allow physician practices to increase their focus on auditing, appeals, and collection of claim payments from payers

Physician practices can automate claim revenue cycle

A physician can automate their claims revenue cycle by requesting that EOBs be delivered electronically which helps to transfer claim payments through an electronic funds transfer (EFT). An electronic EOB in the mandated standard format can be posted into the physician’s system with little or no staff intervention.

An electronic EOB is also known as Electronic Remittance Advice (ERA). Several payers offer EFT programs, which, in contrast to paper checks, use electronic means to transfer money between parties. EFT payments are instantaneous (avoiding postal delays) and may reduce administrative steps associated with issuing or depositing payments. However, the physician needs to review the EFT program to check if the prospective program offers enough flexibility for the physician to maintain banking relationships.

Though the trends for electronic claim submission is rising continuously, certain precautions need to be taken by a physician. For instance, submitting electronic claims directly to a payer must follow the national standard formats and protect the privacy of information.

WE Medical Billers and Coders (MBC) are expert billing and coding professionals to help your practice to avoid the increasingly tiresome paperwork and filing of lengthy forms manually. 

Published By - Medical Billers and Coders
Published Date - Mar-08-2021 Back

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