5 questions to consider when choosing the right healthcare claim submission process for your medical practice
It’s a question every practice manager must ask when thinking about the electronic claim submission process: Will the medical practice submit healthcare claims to payers in batches, or will it send each claim individually?
While not every practice management system permits both options for healthcare claim submission, many—including edgeMED—do. With that said, there is no one-size-fits-all answer, and there’s also no hard and fast rule for healthcare claim submission. While the electronic claim submission process may vary between medical practices, it could also vary within a single practice depending on a variety of factors.
Here are five questions to consider when determining what type of claim submission process might make the most sense for your medical practice (i.e., real-time versus batch processes):
1. Are you concerned about cashflow? Cashflow is always important, and if you’ve had problems in the past, you may want to consider real-time claim submission. When you submit healthcare claims to payers in real-time, you keep the cash flowing continuously. That’s because faster adjudication means quicker reimbursement. On the other hand, batching claims means there could be a delay in payment, depending on how frequently you submit those claims. For example, if you plan to submit them hourly or even daily, it might not be an issue, but if your plan is to do it weekly or even less frequently, this could definitely affect your medical practice cashflow.
2. Do you need to reduce the administrative burden? Most medical practice managers would agree that reducing the administrative burden is a priority. However, administrative burden may be particularly challenging in those practices experiencing chronic healthcare staffing shortages. Fifty-six percent of medical groups say staffing is their biggest productivity roadblock. In these practices, staff may not be able to provide the immediate attention that real-time claim submission requires. When this is the case, batch claim submission may be the only realistic healthcare claim submission option in the short-term. As staffing levels increase, you can reconsider real-time versus batch processes.
3. Are you trying to grow your business? Real-time claim submission can be challenging to manage as claim volumes increase commensurate with business growth, including mergers and acquisitions. Alternatively, batch claim submission promotes the type of efficiency and scalability that’s necessary to expand your medical practice without having a negative impact on cashflow.
4. Are you trying to detect medical coding and billing errors? If you want to identify and fix errors immediately, real-time healthcare claim submission may be the way to go. Submitting healthcare claims in real time allows you to pinpoint errors and implement proactive strategies to prevent denials. For example, you could create payer-specific edits in your practice management system upon immediately noticing a pattern of denials.
Waiting to submit claims—and then submitting multiple claims simultaneously—means these errors could go undetected for longer periods of time, causing additional problems on the back end with the need for costly and time-consuming appeals.
As you consider real-time versus batch processes, ask yourself this question: How confident are you in your medical coding and billing accuracy? Leveraging a claim scrubber can certainly help, but are you sure that the entire batch of claims you send is correct? If not, it may make sense to send one healthcare claim at a time—at least initially—until you get a sense of how the payer processes the information. For example, real-time processing may be well-suited for new procedures or service lines. Likewise, it might be a good option for submitting claims on behalf of new providers in your medical practice or to newly contracted insurance companies.
On the contrary, batch healthcare claim submission might be better for high-volume, routine labs or other services for which there are clear and consistent requirements.
5. Are you trying to reduce system load? Batching healthcare claims reduces the strain on systems during peak hours. Providers can send claims at convenient, non-peak times so there is no drain on productivity.
In summary: Real-time versus batch processes
As practice managers define their healthcare claim submission process, keeping an open mind is paramount. If you’re looking for immediate responsiveness from payers so you can identify and fix errors, real-time claim submission may be the way to go. However, if efficiency and scalability are priorities, submitting claims in batches is much easier. Note that priorities change over time, meaning what works when you’re opening a new medical practice, for example, might not be as effective as you look to grow and expand your practice. Partnering with the right revenue cycle management vendor can set you up for success. Learn how edgeMED can help and be sure to check the Healthy Snacks blog for more expert insights, best practices and industry trends.
