While medical billing typically leads to higher reimbursement rates for hospitals and surgery centers, it typically means loads of paperwork for nurses. Doctors and nurses working in a high-stakes environment do not have the time to check through risk assessment boxes or confirm all patient data is correct.
However, when insurance claims are submitted digitally, it eliminates extra work for medical staff saving time and money.
Brian Stowell, key account manager, works alongside surgery centers or hospitals to implement secure and efficient digital claims processes.
“The biggest thing we are trying to accomplish is creating clinical efficiencies,” says Stowell. “If we aren’t utilizing digital services, the clinical staff has to print or scan paperwork. If we have access to the system, we can capture necessary information for medical billing purposes.
What does it mean to submit insurance claims digitally?
Facilities using software such as PRO-MAPP or Surgical Notes can directly integrate with the Compression Solutions Medical Billing Team. This integration allows our intake specialists to log in to a secure digital environment and pull information such as OP notes OR H&Ps.
“With a digital platform, I don’t have to request additional documentation and wait for it to be submitted,” says Megan Snodgrass, intake specialist. “What typically takes 60 to 90 days to process, we can have it billed within 30 days by using a digital system.”
How is information pulled from these systems?
Intake specialists can pull everything submitted electronically by a facility. Or, documentation can be uploaded by a facility to a virtual Dropbox and shared.
“The goal is reimbursements,” says Snodgrass. “The entire billing process goes faster this way, I’m not waiting for upwards of 6 months to receive a history and physical that’s necessary for medical device reimbursement.”
Here is the typical process of how insurance claims are submitted digitally:
- The physician will order medical devices used for surgery or recovery.
- The patient signs a prescription.
- The facility will send the completed bill sheet via box.com or other software.
- Billing specialists begin to pull patient demographic information, op-notes, medical history and physicals.
- The billing specialist determines what billing it goes to via the insurance.
- Then Compression Solutions will send it to the biller for billing and reimbursement.
- Overall this process takes 30 days, which is a fraction of the typical turnaround time.
Is this process secure?
Compression Solutions is held to extremely tight digital security measures. All devices are encrypted with two-way authentication and are HIPAA compliant.
“With all facilities, we have business associate agreements in place,” says Snodgrass. “That is being done from an encrypted, secured computer.”
In addition, all of the Compression Solutions billing team has had training in HIPAA compliance and secure billing practices.
“Being owned by Essity, we have a giant corporate compliance and legal team,” says Stowell. “We have very robust compliance and security processes in place when it comes to patient data. But, we are also bound by HIPAA guidelines. Bottom line: our company is publicly traded and requires strict security measures to be in place.”
How long does it take to set up a digital claims system?
“Change takes time,” says Stowell.
But, the truth is it depends on the customer’s current system and processes. However, for each facility wanting to switch to a digital claims system, Compression Solutions provides one-on-one support from a key account manager to help streamline the process.
“We walk them through how insurance claims are currently being done and usually everyone can see the inefficiencies,” says Stowell. “Then we will walk through the streamlined digital format and it’s clear that after the first investment of time, it’s so much easier than uploading or faxing information.”
Why invest in digital claims
Digital is the future of the modern surgery center. Submitting insurance claims digitally does save a substantial amount of time. However, it also makes sure data and information is accurate, increasing reimbursement rates and reducing the time from service to billing.