Electronic Medical Claims Filing
Problem: Insurance Companies Hate To Pay What They Owe
many doctors know, the whole process of filing insurance claims
is cumbersome, time consuming and energy-draining. The insurance
companies have made it as difficult as possible to get paid.
Obviously they have a vested interest in paying out as little
money as they possibly can. One of the best ways they hang on to
their money a little longer is by creating an extremely
difficult set of hoops that doctors have to jump through to file
and collect their insurance claims.
This arduous process is probably all too familiar to you
already. First, one must spend an average of 10 to 15 minutes
filling out the CMS 1500’s.
take hours a day if one has numerous patients. If there are any
minute details on the paperwork that are not filled out
correctly, the insurance company rejects the entire claim and
sends it back to you—unpaid. Then one has to figure out what the
problem is, attempt to fix it, and then re-submit the claim and
hope it is right the second time around.
The results of this frustrating process are startling: On
average 32% of all claims are rejected, 5 to 15% are lost in the
shuffle and never collected, and the average time it takes the
doctors to collect their money is 60 to 90 days. It can be even
longer for Medicaid claims.
In addition, aside from stretching the time it takes to receive
payment, this process also presents one with another major
problem: it takes a tremendous amount of employee and overhead
cost for one to manage the entire claims filing process. In
fact, the New England Journal of Medicine states that a typical
doctor's overhead and billing expenses account for 43.7% of
his/her gross income. This translates into an average of about
one and a half clerical workers per doctor at an average annual
cost of $51,564. This does not include the hidden costs like
vacation time, insurance, and the like.
The Solution: Electronic
Medical Claims Filing
Electronic medical claims filing now comes into play. Instead of
relying on staff to laboriously file claims and then endlessly
follow-up on them through the approval and collection process,
now a physician can outsource the entire process to a medical
billing professional. Fortson's Professional Services, LLC can
also lower the time it takes to receive payment from an industry
average of 90 days to as little as 7 days. We are trained
professionals who are equipped with proprietary,
state-of-the-art software that allows us to electronically file
claims for you. The benefits to your practice are enormous.
all know that the Internet has changed our world. Our Practice
Management System is automatically upgraded on a daily basis and
requires no complex installations. You have access to your
client's data 24 hours a day, 7 days a week via the Internet.
Benefit #1: Speeds Up the Payment Process
Next Generation Electronic filing drastically reduces the amount
of time it takes to collect payments from the insurance
companies from 60 to 90 days to just 7 to 21 days. This is
possible because electronically filed claims are handled by
computers instead of human "gate keepers" at the insurance
companies . These "gate keepers" are the ones who ultimately
determine whether or not one should be paid. However, when
claims are handled by computers there are no people to bog down
Benefit #2: Lower Claims Rejection Rates
The rejection rate for claims utilizing our service can plummet
from over 30% to under 2%. Obviously, claims that are not
rejected move through the system more quickly. In addition,
claims that are mysteriously "LOST" by the insurance companies
and never paid are eliminated altogether. Claims cannot be lost
when using electronic medical claims filing because they produce
an acceptance report from the carrier that ensures receipt.
Benefit #3: Frees Your Time
This benefit is not always quite so obvious to doctors, but is
very significant nevertheless: doctors spend as much as one and
a half to two hours a day supervising and working on insurance
claims. At the very least, physicians have a high-paid staff
person working on filing the claims. Our system can give you
more time to either see more patients, and therefore make more
money, or spend more time doing what you want to do. This also
frees up the time of your staff members, allowing them to make
more patient calls and run the office more efficiently.
Benefit #4: Immediate Cost Savings
An office can realize an immediate cost savings when outsourcing
it's billing to us. A recent survey in the Medical Group
Management Journal showed that the average cost of internal
billing departments was 11% of the practices' income. Our
billing services, on the other hand, charge much less to perform
the same service, depending on the volume and complexity of the
Electronic Medical Claims Filing
Doctor Filing Paper Claims
Doctor Filing Electronically
A. Number of Insurance Claims Per Year
B. Average $$ Per Claim to the nearest dollar
C. Total Annual Insurance Billing
D. Percentage of Claims Rejected
E. Number of Claims Rejected
F. Amount of $$$ Rejected
G. Percentage of Rejected Claims NEVER Recovered
H. Total $$ Never Collected
I. Saving From Using Electronic Claims Filing
Frequently Asked Questions
Will my claims really get paid faster?
Most definitely. Electronic claims are always processed before
paper claims, and because of the electronic tracking methods in
place, the insurance companies cannot claim they never received
your claims. With our exclusive next generation technology your
claims can settle with money in your account in as little as 7
How fast will I know if the claims have been accepted?
You will know that the insurance companies have accepted your
claims within 24 hours. You can also check the status of your
claims in real-time 24 / 7 on the Internet.
Will I be able to know at all times what claims have
You will be given a detailed verification report that will show
what claims have been transmitted and when.
Will I have to have expensive equipment and software?
No. In fact, you do not have to have any equipment or software
at all. With our specialized system your office can outsource
all of your data entry of new patients, posting of charges and
payments, and statements.
If you prefer not to outsource, then you can certainly keep your
current software and equipment. Your billing specialist will
only need a copy of the superbill and patient registration form
to perform the billing. The services are completely tailored to
meet your individual needs.
Will my patient charts ever have to leave my office?
Absolutely not! If there is any information your billing
specialist needs, they would contact your office manager and
request it by either fax or phone. Only information that is
pertinent to filing the claim is necessary. All patient
information is kept in the strictest of confidence and is only
used for billing purposes.
So what exactly does the billing
specialist need from our office to file the claims
We will need a copy of the super bill for services
performed, a copy of the patient registration form, and a copy
of the insurance card front and back. If Fortson's Professional
Services, LLC is going to perform full accounting of payments as
well, then we will need a copy of the EOB so we can properly
How will the information needed
to file a claim get from my office to my billing specialist?
Because each office's needs vary, our billing
specialists can work with you on an arranged time to pick up the
necessary data to file the claims.
I do not have a formal superbill.
Can one be designed for my needs?
Yes. Fortson's Professional Services, LLC can even put
the form on two part NCR paper so your office will not have to
make copies of them. The same can be done for a patient
What happens if the claim is
rejected or paid incorrectly?
Your billing specialist will challenge any and all
rejections and will do prompt follow up on any problems.
What are the liabilities involved
in using an outside service?
At Fortson's Professional Services, LLC we take every
precaution to ensure the quality and security of handling your
billing needs. Our software and systems meet or exceed all the
guidelines stipulated in HIPAA. All data is backed up on a daily
basis and is stored off site in multiple remote data centers; a
backup can also be provided to your office upon request. These
data centers use the latest in security and hacker prevention to
keep your data completely safe.
What would my office staff be
Your office staff will be able to continually
concentrate on increasing patient care and follow up on the
status of all the patients who come through your practice. With
this kind of care, your patients will become great word of mouth
referral sources for you.