Billing medical claims electronically – Do you read your reports electronically?

We’ve finally reached the stage where most offices bill at least some of their medical claims electronically. But the main question is: do they read their electronic reports?

Simply submitting the declarations electronically is not sufficient. If you don’t read the electronic reports, you lose money. It is critical to your practice that these reports are read and reviewed regularly. If you say you don’t have time to check the reports then I say you don’t have time NOT to check the reports.

There is so much information on those reports that is necessary to keep your accounts receivable under control. I entered an office where the billing girl NEVER checked electronic reports and NEVER did any follow up. They lost 33% of their progress every month! The doctors had no idea. The problem was she had too much to get done and that’s what she put on the “bottom of the pile” that she never got around to. Unfortunately, this meant that the doctor who owned the practice took a 33% pay cut without having a choice.

The electronic reports primarily tell you whether your full set of claims has been received or not. Just because your file is going from your end doesn’t mean it was received at the other end. Sometimes something as stupid as a “#” in an address can cause a whole bunch of electronic claims to be rejected. Failure to review your reports means that you will not be paid for the entire set of claims due to one clerical error on one claim.

Sometimes your electronic batch is initially accepted at the front end, but after the file is processed, the batch is deleted due to an error. You will receive a notification of this. I recently declined a provider’s Medicare batches because there was a discrepancy between the NPI number on the claims and the NPI number that Medicare had on file. The files were initially received OK, but then the batches were deleted.

One of the other types of reports you receive are payer specific reports. These will tell you if a patient’s insurance has been terminated, if the date of birth is incorrect, etc. If you do not resolve these issues, not only will you not be paid for that claim, but if the patient returns all future claims will also be denied.

You may not feel you have the time to check these reports, but I hope I have convinced you of the importance of making the time. If your practice is supposed to make more money than it is and you don’t check your reports, that’s probably why.