Electronic Claims Processing

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Electronic Claims Processing

• Billie Jo Lukes

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Market Summary

• Market past, present, future
• Past claims processing was a long, drawn out
  process.
• Held until the 27th day after submission
• Errors on claim are sent back for resubmission.
• 30-60 days to send the paper claim through the
  system.
• Receive payment around 45-120 days.

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REJECTION CAUSES

• Patient/subscriber name of ID number missing
• Patients group number missing
• Physician signature (facsimile) missing
• Dates obviously incorrect
• Diagnosis does not correspond with procedure
• Diagnosis does not correspond with service

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REJECTION CAUSES CONT

• Charges are not itemized
• Procedure codes missing or incorrect
• Fee column is blank
• Mandatory diagnosis ICD-9 code missing
• Necessary drug/equipment information missing
• Claim unclear due to poor handwriting

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COST ANAYLSIS REPORTNote This report is based
on 250 claims per month and in-house staff salary
of 8/hour, 5 claims per envelope

• MONTHLY SALARY (Pro-rated 70) 969.00
• BENEFITS (27 of salary)
  262.00
• TELEPHONE (pro-rated 70) 210.00
• HCFA FORMS (.022 per form)
  5.50
• HCFA POSTAGE (0.39 for each 5 claims) 19.50
• ENVELOPES (0.43 apiece)
  21.50
• STATEMENTS (0.15 per form) 22.50
• STATEMENT POSTAGE (0.39 each) 58.50
• OFFICE SUPPLIES
  75.00
• COST OF MONEY
  250.00
• GRAND TOTAL COST PER CLAIM 7.58

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Billies Processing Services

• Electronic Claims Processing is a faster, easier,
  more economical way of filing your Medicare
  claims.
• Reimbursement is guaranteed in 14-21 days instead
  of the traditional 45-120 days.

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IN-HOUSE BILLING

• The competitive landscape
• In-house medical billing has an upside of you
  being able to see them working on your bills.
• Does not have the guarantee of reimbursement in
  14-21 days with or without errors, and the low
  fee of 5-7 per claim.
• Billies Processing Services guarantees
  reimbursement in 14-21 days.

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PAPER VS. ELECTRONIC FILING

• PAPER CLAIMS
• 45 to 120 day payments
• Approximately 70 accepted
• Over 25 rejection rate
• Notification of errors or missing data in 25 to
  45 days
• 2-5 minutes to prepare
• 7- to 15 cost of preparation
• Unmanageable claim tracing efforts
• Extensive labor
• intensive follow -up

• ELECTRONIC CLAIMS
• 7 to 21 day payments
• Over 97 accepted
• 3 or less rejection rate
• Notified of errors immediately
• (software)
• Clearinghouse error notification within 24 hours
• 2-5 minutes to prepare
• 2-5 cost of preparation
• Minimal follow-up required
• Report of prior days claims with next
  transmission

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ASSURANCE

• Billies Processing Services has
• A fool-proof setup with medical billing
• A program that immediately finds errors and sends
  the claim back for correction
• A second error check through a clearing house
• If there are errors, they will be sent back
  within 24 hours.
• Consumer promise
• Billies Processing Services promises to file
  your claims quickly, accurately, and without any
  hassle for you.
• We guarantee payment in 14-21 days, and you will
  never pay one cent more than 7 per claim.

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COSTS

• Fees
• 5-7 per claim.
• A one time set up fee of 300.00
• will cover the time in setting up your practice.
• Also covers maintenance charges of electronic
  claims.
• Benefits
• Never have to pay for HCFA forms or costs
  involving medical processing ever again!
• Dont have to pay extra for postage to send
  claims to me, I will pick them up personally with
  no fees.

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Weighing the costs

• Pricing
• Only 5-7 per claim for Billies Processing
  Services to file your claims electronically, and
  only takes 14-21 days for reimbursement, even
  with errors.
• A claim sent manually normally costs 7.58 per
  claim, and takes 45-120 days for reimbursement,
  if there are no errors.
• Policies
• Upon signing contract, we will negotiate a price
  per claim.

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Billies Processing Fees vs. Competitors

• 5.00/claim _at_ 1200 claims/month 6,000.00
• 7.00/claim _at_ 1200 claims/month 8,400.00
• 7.58/claim _at_ 1200 claims/month 9,096.00
• Save 8,352.00 a year.

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TRY IT AND SEE!

• You can try my services as a two week trial at
  3.50 per claim, and after signing, the first 25
  claims are half off!
• No contracts, no obligations until after the two
  week trial!

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My Mission to You

• To satisfy my clients with successful claim
  processing services.
• My success depends solely on your satisfaction
  with my company.

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QUESTIONS?