Five Solutions to Streamline Electronic Claims Filing

ORLANDO, Fla. — Struggles with reimbursement might feel like they are out of your control, but Mark J. Seitzer of Process Solutions, said with proper management they can help you add to your bottom line.

Seitzer educated attendees of the 2010 American Orthotic and Prosthetic Association’s National Assembly, here , about the processes that are in their control and offered five solutions to better organize claim filing. His suggestions are:

  • Within HIPAA, there is a key provision that enables providers to force payers to exchange electronically. He said, “This is buried deep within HIPAA regulations. It gets complicated underneath … it is rarely used by us, but providers have the right to submit electronically.”
  • The gap between procedures of the provider and requirement of the payer is closed by Implementation and Companion guides – of which a new set will be available in January. “With these guides, your claims and the people who work with your claims can work through them and get paid,” Seitzer explained.
  • “You want to make every effort to get it right … to be successful,” Seitzer said stressing the importance of cooperation among all revenue cycle entities, which include: the provider’s billing system; the provider’s clearinghouse; the preferred provider organization; the payer’s clearinghouse; the payer’s adjudication system and contracted intermediaries. He said that controlling the two within your control and making sure they can communicate electronically with the other groups is key.
  • Seitzer encouraged attendees to get questions answered by top leaders whenever possible. “Scratching and clawing up the provider helpline isn’t going to do it,” he said. “Go up the food chain of the key decision makers.” Payors are obligated to explain why a claim was rejected, he explained. When all other options fail, go to the top.
  • Seitzer said to surround yourself with people who have the answers and can save time and work. “There will be some rough seas,” he said in conclusion. “You have to know how to run the boat.”

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