The Need
MANUAL MEDICAL CLAIMS PROCESSING: Entails a lengthy stream of activity and requires approximately 77 days of processing time. And, if the claim is rejected, it can take up to six months before the doctor receives payment.
Understanding the Need for ECP
Healthcare providers focus primarily on rendering medical services to their patients. As a result, the necessary related administrative functions such as claims billing are often neglected or performed in a less than timely manner. Time and budget constraints as well as lack of expertise and inefficiency contribute to the problem. Doctors often rely on managerial specialists within and outside the office to help meet the demands of medical and patient billing, general bookkeeping and more.
Failing to abide by 100% to the insuring payors' specifications results in a high percentage of rejected claims and delayed payments to providers. Rejected and re-processed claims directly impact the cash flow position of any medical practice. These denied claims generally require extensive follow-up and resubmittal prior to actual payment by the carrier. Medical claims billing is greatly facilitated through the use of an electronic claims processing system because an ECP: (1) keeps track of each carrier's specific requirements, (2) significantly reduces the rejection percentage, and (3) greatly accelerates the payment turnaround time.
Office managers or their designees dedicate a major portion of their time to manually processing claims. The insurance claims are submitted to governmental agencies, health organizations and various private insurance carriers, all of whom have very specific requirements and regulations. Medical claims processing requires industry specific knowledge on the part of the preparer. This is especially apparent in light of the ever-changing requirements imposed by insurance companies and government agencies. Unfortunately, most medical office personnel are inexperienced in claims processing and accounting which, in addition to knowledge, requires accuracy, attention to detail, and timeliness.
Manually processed paper claims result in relatively slow payment to the medical practice. These claims can average up to 10 weeks in processing while the average processing time for electronically submitted claims is approximately 48 hours!
