Practice Management Alert

You can have your electronic claims and your paper attachments, too

If managing paper attachments along with electronic claims makes your head swim, you're not alone. But you needn't fret any longer.
 
Electronic claims are a wise choice since Medicare began penalizing paper claims with a 27-day waiting period for payment - but filing electronically leaves billers wondering what to do with those pesky paper attachments required to prove medical necessity.
 
Certain specialties must attach a lot of supporting documentation to claims in order to get paid. Some practices - fearing that the carrier would never connect the paper attachment with the electronic claim - started sending the claim electronically and then submitting a paper copy with the attachment for easy identification.
 
The problem: This strategy makes it appear that you are trying to double-bill for the service, says Margret Amatayakul, RHIA, CHPS, FHIMSS, president of Margret A Consulting LLC in Schaumburg, Ill.
 
What is the best and most cost-effective method to file claims with paper attachments?
 

The solution: Electronic claims transmission software includes a data field that allows you to indicate that you are sending a paper claims attachment, says Margret Amatayakul, RHIA, CHPS, FHIMSS, president of Margret A Consulting LLC in Schaumburg, Ill. Some practices are already using the correct process - sending an electronic claim and marking that a paper attachment is to follow - and it's been working fine, she says.
 
Check with your software vendor: Any practice management system (PMS) that uses the 837 version 4010A1 claims format adopted under HIPAA is supposed to accommodate the data field that indicates paper attachments, Amatayakul says. "The problem is that many PMS vendors did not fully upgrade their systems," she adds. 
 
Voice your concern: If your PMS doesn't have the capability to indicate paper attachments with a claim, "it's because your vendor didn't provide that function - and they should have," Amatayakul says. Call your vendor and bug them to install that functionality, she says.
 
Benefit: If you file electronically, Medicare will consider your claim eligible for payment after 13 days - whereas paper claims must wait 27 days. And filing electronically may be more cost-effective in terms of mailing expenses and office labor.
 Bottom line: "My recommendation would be to step up to electronic claims," Amatayakul says. But contact your major payers first to inform them you'll be filing electronically and sending paper attachments. Make sure you know exactly how the process will work - you could even try testing the process with some carriers or establishing a written agreement on the terms of the claims transactions.
 
If you have many claims that require an attachment, you don't want to start sending them electronically and then suddenly realize that a carrier's system won't process them correctly, [...]