Transaction Processing
Charge
Capture
Charge capture is a process used by doctors and other
health care providers so that they get paid for their services. In its simplest
form, charge capture is the process whereby doctors record information on their
services, which is then sent out to different payers and insurance companies
for reimbursement. For example, let’s say a doctor sees you in the hospital,
and after 30 minutes of care the doctor diagnoses you with hypertension. Both
the hypertension diagnosis and the 30 minutes of care translate into separate
codes which are eventually submitted for reimbursement.
One of the big variables in charge capture among medical practices is the way
in which doctors record and transfer this information.
Pop Quiz: What are doctors using to
capture their charges?
A) Smartphones
B) Post-it notes
C) Spreadsheets
D) Cafeteria napkins
E) All of the above
Electronic
and Paper Claims
According to a recent study by America’s Health
Insurance Plans (AHIP) indicating electronic submission of 75% (three quarters)
of health insurance claims. This helps practices and providers to process
health insurance claims to process within a month of receipt. This not only
speeds up the claim submission process, but hastens the AR cycle to the
convenience of healthcare provider. In fact, it’s now a requirement by
government payers like Medicare and Medicaid to file health insurance claims
electronically.
In today’s age of getting insurance claims paid the use
of automated technology is very crucial. Tools like electronic medical records
(EMR), electronic funds transfer (EFT) electronic remittance advice (ERA),
real-time adjudication, claim scrubbing services, coding software products and
other technology tools are becoming increasingly necessary. But neither all
practices or physicians have enough finances to invest in these costly
technologies, nor physicians have a considerable amount of time to deal with
such complex processes. Making outsourcing of the claims process an attractive
alternative.
On the other hand, experienced medical billers can
successfully operate technologies available to them to get claims paid and to
reduce claim denials. With the everyday changing insurance policies, it’s
getting harder to collect insurance payments therefore, providers have a great
incentive to utilize outsourced billing solutions.
Direct benefits
- Quicker
claims submission
- Faster
payments
- Improve
claims accuracy – reduce
- Transcription
errors and missing data
- No
printing and mailing costs
- Spend
less time resubmitting corrected claims
- Reduce
paperwork
- 24/7 access to claims tracking
Payment
Posting
Payment posting allows you to view payments and
provides a snapshot of a practices financial picture, making it easy to
identify issues and solve problems fast.
Being able to see daily Insurance payments from EOBs, insurance checks from ERAs, patient payments and more, having an efficient payment posting system provides an efficient view of your day to day financial picture.
WHY IS ACCURATE PAYMENT
POSTING IMPORTANT?
The medical billing process has several steps and a
large number of claims are processed daily, meaning issues are bound to arise.
Payment posting is essentially the first line of defense to identifying payer
problems. Issues such as denials for medical necessity, non-covered services
and prior authorization will be uncovered and can be given to team members to
address.
In addition, catching issues quickly make the entire
process smoother for everyone involved from the front office to back-office
staff.
HOW
PAYMENT POSTING FITS IN THE REVENUE CYCLE
Payment posting should be an integral part of the
revenue cycle, regardless of whether you bill in-house or use a third party
billing service.
A well-done payment posting process can help you
identify opportunities to increase revenue by watching for daily trends within
your practice. Because payment posting has such high potential to increase
profits and smooth out the overall medical billing process, it is important to
get a precise process in place.
Here are six ways payment posting can make your billing
process more efficient and ultimately increase revenue.
EOB and ERA
posting and reconcilement – ensuring data from both EOB’s and
ERAs match payments.
Line item
denials – reporting denials for medical necessity, non-covered
services and prior authorization to management help avoid errors in the billing
cycle.
Denials–
finding denials and ensuring they are reworked and resubmitted to responsible
payers in an efficient manner.
Patient
responsibility – identifying and moving balances to patient
responsibility helps ensure faster patient billing.
Write-offs and
adjustments – processing write-offs, adjustments and looking into
contractual adjustments and passing them to management when issues are
identified.
In-person
collection issues – identifying issues with collecting
deductibles and/or copayments when processing insurance remittances have a
major impact on the overall billing process. By utilizing payment posting,
these mishaps can be avoided.
When payment posting is done right, your practice can thrive. With better cash flow from better collections, problems being spotted faster and dealt with quicker, the entire medical billing process is sure to run smoother. Billing issues can be addressed quickly, secondary payers will be billed correctly and patients will receive their statements promptly increasing the entire medical billing cycles efficiency. Anything you can do to make the medical billing process smoother makes everyone happy!
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