Medical Billing – Electronic Or Paper Claims

By: Michael Russell

Sometimes there are things in life that are very obvious. In the medical billing world, this isn’t always the case. Many on the outside would automatically think that electronic billing of claims is the sure pick over sending paper claims via the United States Post Office. And while electronic billing certainly does have its advantages, is it really the be all and end all of medical billing? In this article, we’re going to take a good look at each method of sending claims. Sometimes the grass is greener but sometimes it isn’t.

Let’s take a look at the facts of each type of billing. With paper claims, you have to either manually fill out the claims by hand, especially if you’re a small office and can’t afford expensive software, or at best you need the software to fill out the claims as they are printed off your dot matrix or laser printer. Most software products for this industry don’t support Inkjet printing. For that matter, most carriers won’t accept anything but laser quality anyway.

With paper claims, you also have the wait. Because insurance carriers are desperately trying to move on over to electronic billing, they process paper claims at a snails pace. It could be anywhere from 30 to 60 days to get paid on your paper claim. This is not a maybe. This is indeed a fact. Paper claims get paid slower.

Another fact of paper claims is that they carry the additional cost of having to keep forms in inventory. These forms are not cheap. Even if you get them included in your software package, the cost of billing a paper claim, at least on a per claim basis, is much higher than electronic transmissions.

Another fact of paper claims is that they have to be mailed. This adds the cost of postage to the already high cost of paper claim billing. Plus, with paper claim billing, there is always the chance that a claim can be lost in the mail. While this is not necessarily a given that it will happen, it is a definite possibility.

Now, let’s look at the facts of electronic billing. For starters, electronic medical billing is faster. The claims are literally transmitted to the insurance carrier in a matter of seconds, depending on how big the claim file is. Larger files do take longer, but for the most part, this is a much quicker process.

Electronically billed claims get paid faster. There is no question about this. Insurance carriers do this as an incentive for medical billing agencies to use electronic billing methods.

Electronic billing requires software and transmission hardware such as a modem or an Internet connection. This adds an expense to electronic billing that you don’t have with paper claims. This is a fact. There is no way to send claims electronically without some kind of software and transmission device.

Those are the facts of each. On the surface, it appears that electronic billing is the hands down choice. But before you make that decision, you must realize that unless you have a large enough client base to justify electronic billing, the cost of the software alone might make it unprofitable. Plus, with electronic billing, you’re going to have technical issues that you won’t have with paper claims, meaning you’re going to have to hire a networking staff and other technical persons.

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