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Efficient Staff Finds that Proactivity Pays

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If the billing department of the Family Medical Center of Hastings published a book about submitting Midlands Choice claims, the word "proactive" would be in its title.  The longest chapter would be about the advantages of submitting claims electronically.

"Our electronic claim clearinghouse's web-based system allows us to edit for missing information before transmitting claims," Gerry Theisen, clinic manager said. "We're aware of any problems within a few hours of transmission. If a policy number is missing or we have an inaccurate CPT or diagnosis code, we can correct errors almost immediately."

Another important chapter would describe Midlands Choice's role as a provider network, not a payer.

A footnote would describe how to use patient ID cards and the Midlands Choice website to assure that claims have current insurance information. There would also be a gentle reminder to stay up to date on CPT and ICD-9 coding changes.

The result of proactive efforts such as these is that virtually all the clinic's claims are in process within 24 hours of one of the clinic's five doctors seeing a patient. They forward claims to Midlands within three to five days, at most. Because careful work has been done before the claims are submitted and they are forwarded electronically, Midlands Choice is able to quickly reprice and forward the clinic's claims to payers, usually within a day.

"With the current environment of lower reimbursements and more patient responsibility for out-of-pocket costs, it's a necessity from a business perspective to get claims turned around on a timely basis, Gerry said. "Also, the sooner we can determine and let patients know where they stand financially, the better it is for everyone."