At a Glance
- Electronic claims submission enhances revenue cycle management by improving filing speed and accuracy and enabling practices to track claims in real time.
- Automating charge scrubbing provides multiple benefits, including reduced claim rejections, better visibility into claim status, and more efficient revenue cycle management.
- Verifying insurance eligibility and capturing coverage details prior to patient encounters helps to minimize claim denials, which in turn helps to protect a practice’s revenue flow.
As your medical practice grows, you’ll need to optimize the revenue cycle to scale the business — and electronic claims submission can help. Submitting clean claims on time is an essential element of revenue cycle management. The more accurate the claims your practice submits, the faster you’ll get paid.
Many critical elements go into the timely filing of a clean claim — correct medical coding, accurate demographic information, prior authorization, and more. This gives insurers many opportunities to deny or reject it, a frustration with which healthcare providers are all too familiar. Research by the Kaiser Family Foundation found that insurers denied 17% of in-network claims for marketplace plans in 2021.One insurer denied 49% of all in-network claims.
Here's how streamlining your claims submission workflow can minimize cash flow disruptions so your practice can continue to grow.
Implementing electronic claims submission protects practice revenue and growth
With electronic claims, practices can trade out cumbersome paper in favor of a more efficient, accurate, and timely filing system. A feature of any good practice management system, electronic claims submission improves accuracy, boosts processing speed, and tracks real-time status. Practices can transmit claims instantly and proactively check in on them.
Electronic claims submission is a first-check guardrail to ensure accuracy. Practices can send primary and secondary electronic claims directly to clearinghouses after entering charges and checking claims against payer reimbursement rules. Built-in charge scrubbing flags common errors, like with billing codes or demographic information, in order to help practices submit clean claims and get paid faster.
Benefits of automating charge scrubbing
Harnessing a system that allows a practice to assess charges before transmitting them to insurers provides substantial benefits. This automated scrubbing:
- Decreases claim rejections: Improves accuracy by reducing demographic discrepancies and coding errors, like under- and over-coding, among other claim elements. Errors are flagged and practice staff can correct the discrepancies before filing.
- Provides better claim visibility: Ensures timely filing and verifies the status of your submitted claims with real-time visibility.
- Improves revenue cycle management: Supports timely filing, improves claim accuracy, and accelerates the payment process to boost cash flow and efficiency.
- Cuts down on overhead costs and administrative duties: Reduces the cost of claim management, which when done on paper requires processing, mailing, resubmitting, and status tracking.
The first-pass resolution rate, claim denial rate, and average reimbursement — among the most important performance metrics for a high-performing revenue cycle, according to the Medical Group Management Association — can all be improved via automation. With this in mind, practices should invest in practice management systems that enable electronic claims filing and automated monitoring to support practice well-being and consistent revenue.
Verifying insurance eligibility and coverage is the first step
While electronic claims submission supports better revenue cycle management, it remains essential for practices to verify insurance eligibility and capture coverage details, ideally prior to seeing the patient. These are critical steps in ensuring accurately and timely claims processing.
Practices should adopt a holistic practice management solution that enables staff to electronically complete these essential tasks, too. Electronic eligibility and benefit verification streamlines the process of confirming eligibility and coverage, and saves practices an average of 21 and 16 minutes per transaction, respectively, according to CAQH.
Practices need a clear policy for verifying eligibility. Providers should work with staff to implement an easy-to-follow system to verify eligibility for every patient. High-performing practices conduct electronic eligibility checks at the point of scheduling and approximately 3 days before the encounter. Consider a practice management solution that digitizes these workflows if you don’t already have one.
The most common reason for claim denial is an issue with the patient’s insurance eligibility. The may have changed jobs, moved, or allowed their insurance to lapse, so confirming eligibility is essential for every patient, at every encounter, to avoid claim denials.
Verifying insurance? Here’s what to look for:
- Insurance coverage
- Effective date
- Expiration date
- Co-pays
- Deductibles
- Policy effective days
- In-network/out-of-network benefits
Collect billing information from patients, too
To support timely collections, obtain billing information when patients present to your practice, including making a copy of their insurance card and a photo identification. Train staff to speak with patients about their responsibility to pay in case their insurance doesn't fully cover the visit — or if they have a balance on their account.
Steps to ensure a high-performance revenue cycle
Submitting clean claims on time is an essential element of your revenue cycle management. The more accurate the claims your practice submits, the faster you’ll get paid.
- Verify eligibility: Confirm every patient’s status and extent of their coverage prior to the date of service.
- Collect payments: Collect any applicable copayments and coinsurance at the time of service; request payment on any balance as well.
- Train staff: Ensure staff, including providers, know how to code so they can file an error-free claim.
- Check for errors in advance: Use an electronic claims scrubber to check for errors before submitting to insurers.
- Automate follow-up: Deploy an electronic tickler to ensure that your practice follows up on claims in a timely manner.
- Appeal denied claims: Implement a process for promptly appealing denied claims. This can help recover revenue that you might otherwise lose.
How to ensure timely claims submission
Ensuring the timely processing and payment of claims often has a lot to do with the workflow of the payer, not the practice. But if a claim doesn't get to the payer within a certain amount of days (60 to 365), it can be denied for timely filing. Even so, there are some steps practices can take to support timely collection of revenue.
- Use electronic charge capture: Implement systems that enable the electronic recording and management of charges. This simplifies data entry, ensuring swift and precise input while minimizing errors, ultimately streamlining the entire billing procedure.
- Leverage scrubbing: Include built-in charge scrubbing, which can detect and eliminate errors in billing codes. Capturing errors upfront supports more accurate claims — and expedites the submission process. Select software that not only speeds up the submission process but also improves the accuracy of claims, reducing denials and rejections.
- Expedite claim submissions: Strive to submit clean claims on the day you see the patient. Delayed submissions may result in postponed payments and have a negative impact on your cash flow.
- Monitor claims post-submission: Track the status of each claim after submission. If the claim is denied, you can quickly address the issue and re-submit to ensure timely payment.
What to keep in mind to ensure timely claims filing
- Make sure you have the proper clinical documentation to justify coded services.
- Use a practice management solution that scrubs charges to identify errors before submitting the claim to the payer’s adjudication system.
- Train staff on your billing system workflows. This includes eligibility and benefits verification: your front-office staff should understand how to verify insurance coverage, identify the patient’s financial responsibility, and communicate this information to them.
By adopting a modern billing system and implementing these strategies, practices can minimize claim denials, improve visibility, and boost reimbursement. A high-performing billing system helps practices file clean claims on time, ultimately leading to faster payments. In today's complex reimbursement landscape, these strategies are essential if your practice is to increase revenue and sustain growth.
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