Electronic claims submissions
Electronic claims are medical claims that are created and submitted virtually. Typically, this is done through a practice management software.
The alternative to this is paper claim, also known as a “manual claim”. Electronic claims submissions are becoming more of the standard in the medical billing world, and for good reason.
There are several benefits to submitting claims electronically versus manually.
Electronic claims submission can be more convenient, time efficient, cost effective, and comprehensive than manual claims submission.
Let’s explore all the advantages to submitting claims electronically, evaluating the best option for you as a provider, and how to get started.
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Electronic claims submission can help therapists who are interested in seeing clients feel less intimidated by the billing process, thanks to the ability to easily submit claims electronically.
Manual vs. electronic claims submission
Two ways of submitting claims to insurance providers for billing therapy sessions are manual and electronic submission.
A manual claim submission is one that is on paper. When billing the Centers for Medicare and Medicaid Services (CMS), the CMS-1500 form would be used. When submitting to other health plans, a Uniform Billing UB-04 form is used.
The form would require postage and would be mailed to the payer.
An electronic claims submission occurs when a claim form is created digitally and is transmitted electronically to the payer to be processed and paid.
The electronic claim form can be generated using digital software. There are also full service and manual submission options when a practice management software is used.
The history behind it
Electronic Health Records (EHR) have been in evolution since the 1960’s. Since then, the shift towards maintaining health records and completing the medical reimbursement process electronically has been encouraged by the government and health plans.
Effective October 16, 2003, CMS began requiring mandatory electronic filing for all reimbursement claims under Medicare.
The American Medical Association (AMA) has expressed encouragement for providers to submit electronic claims. The AMA published a joint paper with the Connecticut State Medical Society in 2013 that outlines the benefits of using electronic claims submissions.
Several health plans require or encourage health care providers to use electronic claims submission. There are multiple reasons for this, which speak to the benefit of using this method over manual (paper) submissions.
Benefits
Here are some of the benefits to using electronic claims submissions:
- Cost effective: Electronic claims submissions can save you money because no paper, printing, or postage is required. Full-service electronic submissions do so much of the work for you, that you won’t need to hire staff to assist with billing. Switching from manual to electronic billing has been shown to cut annual costs by up to 60%.
- Time efficient: Automatic, full-service electronic claims submissions through a practice management software like TheraPlatform can save therapists from using their valued time on manually completing, printing, and mailing submissions.
- Improved accuracy: Human error is inevitable. With electronic claims submissions, digital software can automatically check for accuracy. When errors are identified before the claim is submitted, the therapist can correct them before submitting. That can cut down on processing time and reduce claim rejections. Not every EMR/practice management software offers this option but TheraPlatform, for example, does. It validates each claim to make sure that the claim is clean.
- Faster reimbursement: Electronic claims can be submitted instantly, and providers can confirm the payer’s receipt of the claim. By eliminating the wait for a paper form to be mailed, therapists can expect to receive reimbursement for services sooner.
What is needed for electronic claims submission
For Medicare or Medicaid, there are a few initial steps to take. Practice management software should offer claims submissions that meet CMS requirements.
The first step is to enroll in EDI (Electronic Data Interchange) with CMS. EDI is an agreement executed by the provider to signify that he or she intends to use electronic media claims (EMCs) to Medicare.
Providers will also need to notify their MAC (Medicare Administrative Contractor), which they can do through an online portal on the CMS website.
For Medicare and Medicaid, once these forms have been submitted and the clinician receives notice of successful enrollment, they can start to submit claims electronically.
TheraPlatform’s E-Claim feature is integrated with a major clearing house and supports thousands of health insurance providers. That means providers don’t need to create accounts with any clearing houses - they can instantly begin submitting claims electronically.
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What’s the process look like?
If you’re using a fully integrated practice management software, the software will automatically complete the CMS-1500 form needed to submit a claim.
Using a full-service option for submission, the validation system allows you to review the claim for any missing information and prompts you to fix any errors before the claim is submitted.
If you opt for self service, you can fill out the CMS-1500 form electronically via a direct data entry (DDE) screen.
You can receive updates and check the status of your electronic claims. Once the claim has been received and processed, you as the provider can receive payment through an Electronic Funds Transfer (EFT).
Limitations
Electronic claims submissions have become the standard across healthcare. So, are there any disadvantages to the process? One possible limitation is the reliance on technology. Of course to submit claims electronically, you’ll need a functioning computer and internet access. If you’re experiencing a glitch or difficulty using either of those, there could be a hold up in submitting a claim electronically.
Another limitation could be some extra time and costs associated with learning a new process of billing and purchasing the necessary software to complete electronic claims submissions.
Of course, in the long run the benefits of using electronic claims submissions seem to outway these obstacles.
The best method for you
As a therapist, how do you decide on the best method for you to submit claims?
If you’re comfortable using technology, are interested in saving time and money, and complying with current requirements and recommendations from insurance are important to you, electronic claims submissions are the way to go.
TheraPlatform is a fully integrated teletherapy and practice management software for therapists that helps streamline billing and reduce insurance denials. Therapists that use TheraPlatform have the ability to submit claims electronically to more than 2,000 available payers. TheraPlatform, an all-in-one EHR, practice management and teletherapy tool was built for therapists to help them save time on admin tasks. They also offer a 30-day free trial. No credit card required. Cancel anytime.
Resources
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
