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When is the Right Time to Start Using Electronic Insurance Claim Filing?

Having a private practice means you are also running a business.  Running a sound business requires efficient integration of structure and procedure in order to maximize revenue and minimize expenses.  If you have opted to accept insurance as part of your business model, then figuring out the best, and fastest, way to get paid is always on your mind. 

There are several different ways to process insurance claims, from using a clearinghouse to employing mental health billing services Mental Health Billing Services

Electronic Claims with Clearinghouses:  Clearinghouses provide a one-stop solution to processing insurance claims, no matter how many contracts you have with insurance companies.  If the clearinghouse is integrated into your practice management software, submitting claims can be completed with a single click. There is usually a reasonable fee for these services, which is more than paid back through simpler claim management and increased reimbursement.  The purpose of insurance clearinghouses is to reduce paperwork, claim filing errors, time spent following up with insurance carriers, and claim rejections, all while getting paid faster.  On average, electronic claims are processed within 14 days.     

Mailing your claims:  Another option is printing out your own CMS-1500 forms from your practice management system or completing the forms by hand, and then mailing the completed forms.  While, on the surface, this sounds like a cost-free option, you have to consider the expenses involved with printing and mailing:  46 cents for a stamp, plus the price of paper, ink, envelope, and time.  This strategy can be cost-effective, especially if you are only filing a handful of claims per month.  Beyond a handful, the time to produce these forms and cost in printing, completing, and mailing may become too labor-intensive and expensive to keep up continuously.  For therapists who are mainly fee-for-service, many insurance providers are no longer accepting paper Superbills either, creating an issue for clients who prefer to see an out-of-network therapist and seek reimbursement on their own. 

Using the insurance website:  A free alternative is to go to the insurance company's website to process the claims.  This is a faster option for receiving your insurance reimbursement, and a good approach if you are only on one or two insurance panels.  The downside to this method is that you have to go to more than one place to submit your claims and check the status of those claims, not to mention how long you have to wait on hold to find someone who is willing to help you resolve a rejected claim.  Imagine the workload if you are credentialed with multiple insurance companies, and you can see how quickly this "free" alternative results in a significant loss of your time.

Mental Health Billing Services:  Many practices use a professional mental health billing service that submit your claims to the respective insurance companies.  Although these services can provide your practice with the know-how of processing your claims to a clearinghouse for you, such services are often not only expensive but they also require you to submit session details (dates, times, CPT Codes, client insurance information, etc.) in order to process the claims.  This can take administrative time that you simply do not have.   

So, when is it the right time to make the switch to electronic billing?  Here is a list of questions that can help you assess your practice's billing needs: 

  • Are you spending a significant amount of time preparing your client reports for the mental health billing service to submit your claims to a clearinghouse?  A practice management software system with integrated insurance would submit the claim for a client session in a single click.
  • Are you credentialed with more than one insurance company?
  • How much of your practice is insurance?
  • Are you able to keep up with the paperwork, rejections, resubmissions , and follow-up phone calls to insurance companies on your own?  How much time is this administrative work costing you?
  • Are you seeing your insurance claims processed in a reasonable amount of time, or are you hoping to reduce the reimbursement time?
  • Would you want the ability to track the claims process, from submission to payment?
  • Are you using multiple websites to process claims and lack centralization?
  • Would you have more time to see more clients, and make more money, if you had help and customer support with your claim processing?
  • Are you a fee-for-service practice that is seeing Superbill rejections by insurance payers to your clients?
  • Is your mental health billing service collecting quickly enough for you, or are you experiencing a large number of unpaid claims building up?
  • Are you losing income because of the administrative challenges of submitting claims?
Several  years ago, insurance companies were all open to accepting mailed CMS-1500 and Client Superbills, but this is quickly becoming a thing of the past. Insurance companies spend approximately 35% more to process paper claims manually than they do to process claims submitted electronically.  It's no wonder insurance companies are veering away from time-consuming  and expensive paper claims, and opting for the faster turn-around of electronic claims.  It's less expensive for insurance companies, and you, the provider, get paid faster.  A win-win for everyone!


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