.
What is an electronic
claim?
It is the same information about patient encounters that you provide to
insurers sent by computer instead of U.S. mail.
If you would like to install electronic claim software that runs along
side ANY existing practice management system call us at
1-800-371-9278
If you would like to install practice management software in an
existing practice or clinic...call us at 1-800-371-9278
What is
a clearinghouse?
Clearinghouses collect data, i.e. electronic claims, translate it to a
digital format that is readable by the recipient, and transmit it. a
clearinghouse, collects electronic claims from providers and checks for
missing or incorrect information using an extensive editing process.
Properly formatted claims are then translated into HIPAA compliant ANSI
format. They are then grouped and sent in a batch to each insurer. If
claims are rejected during the editing process, they are sent back to
the provider with a report of the needed corrections. They can then be
resubmitted.
Why
should I send claims electronically?
Bottom line first: you become more
efficient, receive payment faster, and recover more of your charges.
Additionally:
You
eliminate the time-consuming tasks of printing, stuffing and mailing
claim forms.
You
dramatically reduce the time it takes for your claim to reach the
payers' computer system. Claims leave your computer, move through the
clearinghouse and are sent onto the payers' system within 24 hours.
Your claims
are electronically edited for errors before being forwarded to payers.
You have
proof of filing, unlike mailed claims.
You bypass
the mail delivery service.
You bypass
the payer's mail room.
You bypass
the scanning and re-keying process at the payer location.
It is estimated that more than 6 billion insurance claims are filed
each year or around 500 million claims per month. Of those claims, only
40% are filed electronically. About 60% are still filed manually or on
a paper claim form called a CMS 1500 (formerly HCFA 1500). Medicare
alone receives more than 500 million claims per year.
FACT:
Electronic Claims Processing reduces payment turn-around time by
shortening the payment cycle.
FACT:
Electronic Claims Submissions formats have been mandated by Congress.
You can help by providing electronic claims processing and medical
billing services for all types of healthcare providers in the required
format.
FACT:
Electronic Claims Processing and Medical Billing can reduce average
error rates to less than 1 or 2% by filing claims electronically.
Paper
claims contain errors on them which significantly reduces payment
turn-around time.
About 30 to 35% of all paper claims are
rejected due to typos, errors and omissions. Electronic Claims are
submitted to the carrier via the internet after being checked for
accuracy by the Clamsflo Electronic Claims software.
This audit/edit process reduces the normal rejection rate of 30 to 35%
down to around 1 or 2%. By checking electronic claims for accuracy up
front, the claim is put in a payable status when it is received by the
insurance carrier, thus reducing payment turn-around time.
Annual healthcare expenditures increase by more than 10%. Each year,
for the rest of this decade, it is estimated that there will be more
than 4 million babies born, 20 million children will be below age 5,
over 4 million people will reach the age of 45, and more than 2 million
people will turn age 65. The average person accounts for 6 physician
encounters per year. More than 220 million Americans are covered by
some form of health insurance.
Fact:
Insurance carriers spend in excess of $19 billion annually processing
paper claims.
Fact:
Healthcare providers spend more than $7 billion annually just
submitting claims to carriers.
Fact:
According to the New England Journal of Medicine, the U.S. Healthcare
System wastes up to 24 cents out of every dollar on administrative and
billing costs, or in excess of $6 billion annually.
Fact:
30 to 35% of all paper claims are rejected due to typo's, errors and
omissions.
Fact:
Less than 1% of electronic claims are rejected.
Fact:
An electronic claim takes just seconds to prepare.
Fact:
Most electronic claims are processed for payment by carriers within 24
hours.
Fact:
Electronic claims cost healthcare providers between $1.50 and $3.00
depending on volume, specialty and other factors.
Fact:
Using paper claims submission, reimbursement takes an average of 90 to
120 days.
Fact:
Electronic claims are paid within 7-21 days.
Fact:
Reports show that the average healthcare provider has more than
$150,000 in outstanding accounts receivables.
Fact:
Electronic Claims Submission can reduce outstanding accounts
receivables by more than 60%.
Fact: Coding
errors for surgical procedures eats up about $6 billion annually in
unneeded costs.
Fact:
Medicare provides healthcare coverage to some 35 million people over
age 65.
Fact:
The social Security Administration estimated some 2.2 million people
turned 65 in the year 2003.
Fact:
That number will rise to 4.2 million in the year 2027. In all, 74.9
million people will turn 65 during the next 25 year period, creating a
future of opportunity.
Five reasons to start submitting electronic claims today
1. Make
billing simpler
Electronic
claims submission streamlines billing. Claims are sent to a
clearinghouse with the press of a button, and the clearinghouse takes
care of sorting and sending claims to carriers. You no longer need to
print, copy, sort and mail claims. (Of course, if you ever need a copy
of a claim, you can either view it your PC, or print out a copy.)
2.
Minimize cash flow disruptions
Electronic
claims can be processed faster, which could mean quicker payment.
Nationally, more than 45% of electronic claims are processed
within 48 hours of receipt, another 40% are processed within 96 hours
of receipt.
3.
Receive fewer claim rejections
Because
the Claimsflo Electronic Claims software edits claims before sending
them on to carriers, any
claims with missing or invalid information are immediately available
for edit and resubmission instead of up to two weeks for paper claims.
4.
Control paper flow
Electronic
claims submission reduces your office's paperwork burden and frees up
staff time to handle other important tasks, such as coordinating
treatment plans, collecting payments and scheduling recall
appointments.
5.
Maximize your computer's capability.
Get
your money's worth from your office computer by submitting electronic
claims. Call Claimsflo today at 1-800-371-9278
and ask about a software package that
includes electronic claim submission capability.
