Health Care Quality Special Reports

Online Clearinghouse Reduces Claims Denials, Boosts Cash Flow July 2010 Practice Management Edited by: Rev DiCerto Only about 20% of the 12 billion health care claims submitted annually to commercial and government health care payers are paid correctly, according to a report last month by the American Medical Association. The rest—a staggering 80%—are paid inaccurately, the AMA said. When payments are made incorrectly, particularly if payments are denied or delayed, cash flow and profits for physicians suffer. Among those 12 billion claims, about 3 billion, or approximately 25%, are submitted on paper, and physicians know that electronic claims get paid faster than paper claims. Before it started using an online claims submission process, Comprehensive Pediatrics in New York was well aware of the problems and pitfalls that result from delayed and denied claims. The practice has eight pediatricians working in three locations in Brooklyn and Staten Island and a total staff of 45, including 15 medical assistants, 15 front desk workers, medical room staff, nurse practitioners, two physician assistants, and three registered nurses employed on a per diem basis. For such a large practice, it’s important to file as many claims electronically as possible, says Martin Berman, a medical billing consultant with Creative Health Care Consulting. As a consultant for Comprehensive Pediatrics, Berman seeks to ensure that the practice gets paid in a timely fashion. To do so, he uses an online medical clearinghouse. The medical clearinghouse is MD On-Line in Parsippany, N.J., which specializes in submitting and reporting claims to payers. Berman and Comprehensive Pediatrics have used MD On-Line to eliminate most of the guesswork, delays, and other inefficiencies associated with claims submission, speeding the payment process and improving cash flow, he says. Claims Denied Before working with MD On-Line, Comprehensive Pediatrics suffered from the same claims submission problems that other medical practices face. “ .... You must sign-in to read complete article. If you are not registered click here. Username: Forgot it? Password: Financial support for this Website is provided by Premier Healthcare Resource.

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