How Often Should Your Ophthalmology Practice Submit Claims?

By Michael Carroll on June 13, 2018

Did you know healthcare practices and organizations spend $250 billion each year processing a total of 30 billion healthcare transactions? Your claims submission process is critical to decreasing the economic toll of claims processing for your office. A study performed by PricewaterhouseCoopers found that the average healthcare organization spends $20 in labor to file each paper document, $120 in labor searching for misfiled documents and $220 to re-create a document. Claims processing is directly related to the financial health of any healthcare practice or organization. The frequency that you submit those claims and how you submit them affects cash flow and your office’s efficiency. Here’s how.

The Advantages of Submitting Daily

Whether you are filing electronically or using paper files, it is critical to submit daily. When claims are not submitted in a timely manner, you run the risk of missing payer deadlines. If a denial has a reason code that states, “timely filing exceeded,” you have no right to appeal. It is over. That money is lost. If claims are denied or rejected for other reasons, follow-up work and resubmission take even more time, delaying payment by weeks or months. Those delays directly affect the practice’s cash flow. Additionally, delayed submissions mean patient statements are not updated accurately. Your patients will be less likely to pay their out-of-pocket costs if they know the statement is not accurate and your office is still working on getting insurance to pay. Up-to-date, accurate, real-time statements send the message that your office is efficient and on the ball. When patients know their statements are accurate, they trust you will hold them accountable for their portion as well. The only way to achieve that level of accuracy and efficiency is to file daily.

Do not be deceived into thinking that batching claims and submitting weekly is more efficient. Note the scenario described by Physicians Practice. Insurance companies accept files that are batched together from multiple dates of service. They might pay the first two, skip the third and then pay the fourth and fifth. The third date is denied for missing the filing deadline, even though that may not be true. As quoted from P.J. Cloud-Moulds’ article, “I call this a delay tactic by the payer. Deliberate or not, they are delaying payment to you, the provider, because their system did not accept that missed date of service.”

We do not want to impute bad motives to the insurance companies. Batching multiple dates may just cause payers to be more likely to make errors. The advantage of filing daily to you is these errors are greatly reduced and it’s easier to for you to track and resubmit a claim denied in error. Additionally, staff do not have to keep track of multiple payer deadlines if they know the process is simply to submit on a daily basis.

The Advantages of Electronic Filing

We can’t talk about the importance of filing daily without discussing the benefits of electronic filing. While paper files can be submitted daily, it is much more cumbersome and costly. Consider the benefits of filing electronically.

  • Get paid faster. Filing a paper claim can take five to seven weeks for processing. Electronic files are typically paid within two weeks. It is easy to see how reducing the wait time by over a month can dramatically affect your cash flow. Payments come via electronic transfer, instead of waiting on a check to be mailed. Additionally, many payers offer real-time updates when electronic claims are filed. You can find out in just seconds if the claim was accepted. If you submit a paper claim, you may have to wait a week or more just to verify that the claim was received and accepted.
  • Save money. Research from CAQH showed that it costs $1.36 to submit a paper claim, while electronic submissions cost only 35 cents. That is a savings of almost 75%. Imagine reducing the administrative cost of claims processing by 75% over the course of an entire year. This does not include the cost savings from eliminating the expense of printing, postage, delivery and envelopes.
  • Prove you filed on time. We already discussed the discrepancies that may result when multiple dates of service are filed together. Filing electronically on a daily basis makes it easy to prove to the payer that you did submit on time. You can also easily track the status of a claim. So, you’ll know immediately if a rejection or denial occurs and can take immediate action instead of waiting weeks for payers to communicate with you via mail.
  • Reduce denials. Using a PM to file electronically has several functions that reduce errors, in turn reducing denials. Claims are often “scrubbed” or checked against a set of validation rules. This gives the practice a chance to correct errors before the claim is submitted. Most PM systems also offer electronic verification of insurance eligibility, the most common reason for claim denial.
  • Get critical reports. Filing electronically gives you access to key data that enables you to project revenue and accurately monitor cash flow. If you are unsure about a claim’s status, it’s difficult to project where those claims will fall in your revenue cycle. An efficient PM system allows managers to inform key players about revenue changes and fluctuations based on the timing of payments. Denied and rejected claim reports can also be generated so they can be resubmitted quickly. Additionally, those reports help managers identify holes in the accounts receivable process. What denials are most common? What steps can be taken to prevent the most common denials?

MedCityNews put it well when it said, “Electronic billing services serve as a miraculous achievement of modern technology and should be utilized to full potential.” An efficient electronic billing solution makes it possible for your ophthalmology office to submit claims on a daily basis. Even minor delays in claims processing can significantly affect the velocity of your cash flow. Transmitting claims electronically ensures they are delivered accurately and on time and gives your office managers the power to get real-time confirmations and status checks.

The electronic billing solutions offered by Agnite Health LLC, an affiliate of Advantage Administration, Inc., are helping our clients improve their claim submissions processes and their revenue stream. Learn more about how we can support your practice’s billing process by contacting our team. We have over 25 years of experience specifically in the ophthalmology industry and can help your practice stay current on coding requirements. Contact us today to learn more.