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Third-party billing: The best technologies for electronic claims submissions

Our ratings are based on ease-of-use, accuracy, and time-savings. For each of three technology types, the focus is on the treatment claim submission process and reconciling the third-party payments.

Insurance provider’s web portal
Most third-party insurance providers offer an online portal that practitioners registered with the provider can access to submit/process treatment billings on behalf of their patients. You start by signing into your account then entering the patient data and treatment information for each claim: appointment date and time, billing amount and other claim-related information. If you are good with a keyboard this can take you up to three minutes per claim. Make a mistake and your claim could be rejected and may need to be resubmitted.

Once the claim is submitted, you will receive direct deposit payment from the insurance provider, usually within a few days. Once payment is received, you will need to reconcile your patient’s account within your accounting system. This reconciliation is handled within your accounting records, completely independent of the insurer’s web portal.

Rating: Good. While it does simplify submitting claims, it is a much more manual process that is subject to error and more time-consuming. However, you are submitting electronic claims for your patients, which is a good start.

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Compatible third-party billing practice management systems
In this scenario you are using a web-enabled practice management system that helps process billing claims to a third-party provider. Usually a button or link (a short cut) to the insurance provider’s web portal is made available as part of the treatment billing process within the system. Clicking on the link will open a second browser session that takes you to the insurers web portal – allowing you to sign in to your account. Now, you can view your treatment/billing information from your practice management system in one window and copy (or type) the information into the claim section of the insurer’s portal in the second window. This process is made significantly easier if you have two monitors.

Like the first example, once payment is received, you reconcile your patient’s account within your accounting system. Reconciliation should be less time consuming for you if your practice management system provides you a consolidated list of outstanding invoices due from third party insurers. In general, compatible practice management systems make working in the two-separate systems smoother, however, the patient billing and claim submissions are still being managed from two non-integrated systems. In most cases, this process can require in the neighborhood of 20 mouse clicks and multiple lines of form fields to be copied in order to process and reconcile a claim.

Rating: Better. Although you are still using two separate systems, short cuts built into the practice management system do save time and allow copying of data into the claim form does decrease the likelihood of error.

Integrated third-party billing practice management systems
Here you have a web-enabled practice management system that has partnered/fully integrated into insurance providers’ billing processes – your system is communicating directly with the insurer’s billing system, bypassing the web-portal completely. This provides seamless, real time, treatment claim submission for practitioners.

There are not multiple windows to manage, no double entry or copying of data, no logging into claims systems, no filling out the additional lines of information, no need for two monitors and zero chance of entry mistakes. You have only one or two clicks to submit electronic claims and the same is true for reconciliation of payments.

Most insurance providers offer a predetermination feature that lets you know immediately what your patient’s coverage will be. This tells you if you need to collect additional moneys from your patient to cover any difference between your treatment fees and what percentage their insurance covers. With an integrated solution, this function is built into the appointment check-out process. While you are billing a treatment, you can simply query the insurance provider, which will then auto-fill the invoice with the amount covered, then simply add a cash (or other payment method) line item to the invoice for the remaining amount.

Payment reconciliation is as simple as viewing the list of outstanding third-party invoices and checking off the payments as they are received. The system automatically reconciles the patient account for you.

Rating: Best. This type of system takes the cake for ease of use, accuracy and time savings.

Jessica Foster writes on behalf of mindZplay Solutions, provider of massage therapy websites and practice management solutions. To learn more, visit www.massagemanedger.com.