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Foundations of the Billing and Collections Process

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It’s a common misconception that you have to submit all insurance claims electronically. Even Medicare doesn’t require practices with fewer than ten employees to submit claims electronically. Some carriers actually require paper billing–especially personal injury and worker’s compensation claims.

Paper Claims

Electronic claims processing is still the fastest, most efficient way to file insurance claims, where possible. However, there are times when a paper billing process still applies for your practice. Like all the important processes in your practice, it should be managed in a “standard operating procedure” fashion—meaning that it’s written down and done the same way each time.

Here’s how to file the old-fashioned way:

  • Send weekly paper claims. Because both PI and Workers Compensation claims usually need copies of office notes attached, it needn’t be done daily. Plus, your practice probably doesn’t have a high enough volume to require it.
  • Even if you want to bill every day, it won’t do much good. Adjusters tend to process these claims monthly or bi-monthly. Daily billing merely costs more in postage. Worse, it suggests that you do a high volume of these types of claims raising a red flag. Consider how often the payer processes claims and customize your mailing schedule accordingly.
  • Submit a clean claim. That means all the blanks are filled in, the patient’s ID number and group claim number are in the right field, any secondary payer information is included, the DC’s PIN and NPI numbers are listed correctly, using the proper modifiers, and use box 14 to indicate you initiated treatment within the recommended time.
  • Note: Most carriers scan the 1500 form into their computer systems. A single misplaced keystroke can delay or reject your claim.
    • Use typewritten characters in 10 or 12 font
    • Use standard print fonts – letter quality only
    • Do not mix fonts on the same form
    • Do not use italics or script
    • Use uppercase letters for all alpha characters
    • Do not use special characters (e.g., dollar signs, decimals, dashes, or other symbols/ special characters)
    • Do not use rubber bands or staples on claims
    • Enter all information on the same horizontal plane
    • Align all information in the designated fields
    • Submit only six line items per claim. Do not try to squeeze two lines of information onto one line.
    • Do not print, handwrite or stamp extraneous data on the form
    • Most require the red OCR ink 1500 forms. Don’t submit on Black and White Paper unless you’re sure it will be accepted.
  • Corrections may be made with white correction tape only—do not use correction fluid. Crossed-out or written-over information can cause recognition problems.
  • The claim form must measure 8 ½ x 11 inches and will scan better if left unfolded— send it flat in a 9 x 12- inch envelope. And naturally, no smudges, tears, or illegible entries.

Sadly, sometimes claims processors get in the way of saving a tree. But if you submit paper claims correctly, you’ll save time and get paid more quickly.

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By Kathy Weidner

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