The claims submission process begins with assuring your documentation fully supports the claims submission process and identifies all the charges to be captured. How you document and what you bill for are both critical to the story you are telling payers about your practice in today’s healthcare environment. Your internal business policies, processes and procedures are also keys to charge capture success. CRS claims submission process first looks upstream at these important factors that come into play before submitting your claims.
It is easy to have the misconception that once data entry is complete, the rest of the reimbursement process is automatic. These assumptions often lead to a loosely monitored process and lost revenues. This is even truer for fully integrated EHR and PM systems where the EHR automatically codes the encounter. With the push of a button, off goes your claim. No more super-bills or routers, no more transcriptionists, no more coders and no more billers! At least that is what the EHR venders want you to believe! To bad for you it isn’t true.
Though certain efficiencies are gained, the assumptions that these systems make need to be tightly defined by you and then closely monitored for accuracy. How closely has everything to do with how well your system has been set up and optimized. Claims submission has been simplified by new technology when set up properly, allowing valuable resources to be directed to other steps in the RCM process that are all too often neglected.
At CRS we document every minute we spend on every task in the RCM process. After collecting three years worth of data on a variety of relationship structures, we can tell you that fully integrated software systems save 28% of the time it takes to complete the billing process as compared to paper clinical documentation processes. That is certainly worth it but it is probably not as big a difference as most software companies would lead you to believe. Any higher number is simply not based on unbiased data. We can also tell you that 70% of that 28% gain in productivity, comes from the claims submission part of the process. The other 30% of the 28% gain comes from electronic payment posting efficiencies. No gains in productivity or efficiency are found in what it takes to follow up on already submitted claims. In a properly run billing operation, follow up accounts for 50% of the total time spent on the entire billing process. CRS provides expert claims submission services, submitting clean claims 99% of the time either on your practice’s system or through our PM system.
My practice has been using the services of Certified Reimbursement Solutions since we opened in August of 2005. We have also referred...read more
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