Medical Office Workflow Step 4: Collecting Your Charges and Filing Claims

By properly registering your patient and verifying their benefits, you have laid the groundwork for correct claims reimbursement.  See these previous articles for more information:  New Patient Checklist and Proper Insurance Verification.

You now need to establish a reliable process for collecting charge date and filing claims.  One of the best ways to accomplish this is to utilize your Practice Schedule.  You will want to verify you have received a charge slip or “superbill” for each patient that has been marked as seen on your schedule. 

Integrating multiple systems can enhance your work environment and improve efficiency. A medical billing software that is able to directly import charge data from your EHR will eliminate the need for manual charge entry from “superbills”.

Iridium Suite Practice Management software now comes with the Connectivity Clearinghouse enabling connections to multiple EHR systems.

To prevent denials and receive proper reimbursement:

·         Be aware of any services/procedures you provide that may conflict with others or be bundled together according to NCCI (National Correct Coding Initiative) edits.

Iridium Suite features a built-in claim scrubber that has many capabilities, so a biller can be confident that coding violations will be caught before the claim is generated. 

This article contains additional information on preventing common claim denials: http://www.iridiumsuite.com/mbs-blog/prevent-these-high-volume-claim-denials

·         Stay informed of your commercial payers’ Medical Policies and government payers Coverage Guidelines. 

 These two articles can provide more detailed guidelines on payer’s policies:  Reviewing Commercial Carriers Medical Policies/Clinical Guidelines and Understanding Medicare Fiscal Intermediaries.

Now that you have entered your “clean claims”, it is time to get them off to the payer.  Filing your claims can be done:

via paper on the standard HCFA-1500 claim form,

 or sent electronically. 

Sending claims electronically utilizes Electronic data interchange (EDI). EDIis the structured transmission of data between organizations by electronic means.  Claims are batched in the medical billing software, and then transmitted in an electronic format directly to the payer or to a clearinghouse.

Iridium Suite utilizes EDI to improve your claims processing in the following ways:

·         Ability to track the Electronic Claims from receipt by the clearinghouse to the acknowledgement and acceptance by the payer.

·         Electronic claims are pre-screened for certain errors with notices being sent back to the medical practice within days for quick correction and resubmittal.

·         Due to their formatting, electronic claims are much more quickly processed by the payer, reducing the wait for reimbursement in some cases from weeks to days.