Efficient claims handling: A gift that keeps on giving

Physician practices can take advantage of electronic claims processing to lower costs, save time and minimize headaches.

Posted Nov. 14, 2011.

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As the nation heads into the year-end holiday season, the American Medical Association wants more physicians to give themselves the gift of an improved, streamlined insurance claims process.

The AMA has designated November as "Heal that Claim" month, the official annual kickoff to the "Heal the Claims Process" campaign that the Association has waged since 2008. The effort is designed to improve the way physicians and insurers work with each other when it comes to filing claims and receiving payment.

Physicians know that much of the improvement needs to come from the health insurance side. Too often insurers bungle claims, leading to wasted time and money for practices that must sort out the errors. In some cases, payers are inaccurately handling more than a third of the claims they receive from doctors. The AMA's annual insurer report card demonstrates that payers must be doing much more to get things right the first time.

But there also are steps that more physicians can take on their own to make the process go more smoothly. One major improvement many practices have yet to make is adopting electronic claims systems and standards.

The claims process poses a certain amount of hassles no matter what, but those downsides can be amplified when physicians are still dealing with paper-based claims or other inefficient systems. Practice staffers spend more time on the phone resolving insurance eligibility questions, wait longer to receive payment for services and take more time trying to rectify any mistakes that happen along the way.

All of those extra hours of work translate into higher costs for the physician for what is often a less desirable outcome.

For many medical practices, electronic claims processing would alleviate most of these costly headaches, but some might not know where to start. That's why the AMA is offering a wealth of resources to physicians who find the idea of a more automated practice appealing (link).

New AMA tool kits and webinars offer free advice to anyone considering making the move to paperless claims and can help with navigating every step of the way. The Association's online Practice Management Center now offers a Paperless Practice Group that allows doctors and others to seek recommendations and offer personal tips on how to implement a more improved system.

Physicians can pledge through the AMA campaign that they are committed to adopting key electronic transaction standards and implementing important claims processing efficiencies in their medical practices -- sending a strong message to insurers that doctors are willing to do their part to improve the situation.

Electronic claims processing is not a panacea, and it is not necessarily the obvious choice for every practice arrangement. But too many physicians have realized its promise and have shared their success stories through the Heal the Claims Process campaign for a practice to dismiss the possibility without careful consideration.

As physicians prepare their practices to start another challenging new year of caring for patients, they should consider taking some time in November to contemplate how much more smoothly 2012 might go if they do what they can to heal that claim.

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