Electronic claims submissions
Electronic claims submissions can help therapists who are in private practice feel less intimidated by the billing process, thanks to the ability to easily submit claims electronically.
Electronic claims are medical claims that are created and submitted virtually. Typically, this is done through a practice management software.
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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.
What are two ways electronic claims can be submitted?
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.
Watch the video for details on Paper vs. Electronic claims submissions
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The history behind electronic claims
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.
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Benefits of filing electronic submissions
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 submissions?
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 does the electronic claims submission process look like?
Electronic claims submissions via practice management software
If you’re using fully integrated insurance billing with practice management software (e.g., TheraPlatform), the software will automatically complete the CMS-1500 form needed to submit a claim based on data you enter under the client’s chart and your practice’s information. The software will generate a file that is then submitted to a clearing house, which pushes this file to health insurance.
Practice management software like TheraPlatfrom also has a validation system that reviews the claim for missing information and prompts you to fix any errors before the claim is submitted, reducing the number of rejected claims due to missing or wrong information and improving the speed of reimbursement.
Once the insurance company processes the claim, the practice management software will update the status so you know if it is paid for and if you need to address any issues in case of rejected or denied claims.
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 of electronic claims submissions
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.
How EHR and practice management software can save you time with insurance billing for therapists
EHR with integrated billing software and a clearing house, such as TheraPlatform, offers significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
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Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports mental and behavioral health, SLPs, OTs, PTs in group and solo practices.
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
- Insurance billing 101
- Practice management tools
