7 Best Practices for Claims Submission

Best PracticesIn our previous blog we walked you through the complexity of submitting a clean medical claim. In this blog we will walk you through 7 best practices of medical claims processing to employ when managing the claims submission process.

1. Watch your Charge Lage - Submit Claims on a Daily Basis

A medical practice should generate and submit claims on a daily basis. Submitting them once a week will delay your payments by one to four days. Over time, this delay may significantly impact the velocity of your cash flow.

2. Submit Electronic Claims

Payers are increasingly mandating electronic claim submission. This saves the medical practice costs and reduces the turnaround time for payment of the claim. It is estimated that 69 percent of electronic claims are processed in seven days while only 29 percent of paper claim are processed within that seven-day window! Electronic claims are easier to submit and apply validation rules for a higher clean claim rate.

3. Institute an Edit Function for Paper Claims

If you have to continue with paper claims for some payors, consider a manual edit function to ensure the claims are accurate and complete before they are mailed. It takes less time and money to correct the error before the claim is released than to fix the error after the claim has been processed, adjudicated, and denied by the payer.

Use this review process to also ask the question, "Why does this claim have to go on paper? Can it be submitted electronically?" Many medical practices are not aware that some payers will accept attachments, documentation, and authorizations electronically or via fax avoiding the need to send a paper claim.  Ask your billing service provider about claims transmission preferences of your top payers.

4. Resolve the Root Cause of Claim Edits

Reduce the number of claims hitting an edit by tracking the root causes of your most frequent errors. Once the reason is determined, work with your staff to make changes to process workflow and/or train on necessary coding requirements to prevent future occurrences.

Many claim edits are due to errors or omissions in the data that populate your claims. Your provider's name, the location of the service provided, and other required data elements are entered at the charge entry process. If the information is not entered correctly, it will not appear on the claim form in the correct formats and fields. In order to reduce claim edits, provide training for your staff on the required claim fields and how they map to your practice management system.

5. Reporting and Analytics

Good analytics and reporting allows practices to efficiently sort pre-billed claims and denials for rework.  A best practice for creating an efficient workflow is grouping claims by issue so team members can efficiently work similar claims, thereby reducing turnaround times.  It is also conducive for the identification of trends that contribution to denials and days in A/R.

6. Policies and Procedures

To continuously improve effectiveness and efficiency of the evolving requirements of an effective Revenue Cycle, in-depth policies and procedures that support a continuous learning model are warranted.

Some of these include:

  • Developing a well-documented claim-correction process
  • Trending issues by payer to identify critical issues
  • Collecting accurate documentation on all payer-related issues to support effective contract negotiations
  • Creating a culture of accountability for departments, teams and individuals
  • Tracking preventable denials back to the source for a permanent fix

7. Claim Filing Deadlines

Claims must be filed in a timely fashion.  The claim filing deadlines vary by payer, most payers maintain 45- to 90-day filing deadlines from the date of service. That is, the payer requires that the claim for payment be submitted no later than 45 to 90 days after the service is provided. If your practice is using a modern claim edit engine, the filing deadlines can be built into the system.

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