Outsourced Claim Creation for Physician Practices

A great deal of expertise goes into running a successful physician practice – from the skilled clinicians who deliver patient care, to the front- and back-office staff who manages the business aspects of the practice. Yet, after focusing on the care delivery aspects of the business, many practices often don’t have enough time to properly focus on their billing tasks. This prevents practices from earning the maximum reimbursement for the services they performed.

In these situations, outsourcing billing tasks – such as claim creation –  is worth consideration. Claim creation services are able to devote their entire attention to the practice’s revenue cycle management (RCM) process, and are focused on keeping up to date with ongoing regulatory changes to reduce claim denials and maximize reimbursement.

Once a practice outsources its claim creation, the process is initiated with one of two options to begin claim creation:

  1. The practice scans superbills and patient demographics to electronically send to the claim creation team. This may also include scanning the billing data and consult information from hospitalists to send to the claim creation team.
  2. The practice ships superbills, patient demographics, and other relevant billing information to the claim creation team.

Once documents are received by the claim creation service, there are typically two ways to generate a claim:

  1. Manual Claim Entry: Before any claim is generated, patient insurance verification is done. Claims are then created from a route slip, superbill and other billing information. Claims are then scrubbed for errors that may cause denials. Once claims are created, they can be either sent back to the practice for submission, or the claim creation service can electronically submit the claims.
  2. Electronically Generated Claims: This process is sometimes known as Autogeneration. These claims are created using the evaluation and management (E&M) coding engine within the practice’s EHR interface. Additionally, these claims can be created by using the electronic superbill within the practice’s EHR system, or can use the charge capture system within the practice management system. Auditing of the newly created claims can still be done before submission by either the practice or the claim creation service.

Outsourcing the claim creation process benefits practices on multiple levels. It enables them to remain focused on care delivery, while also ensuring that they receive maximum reimbursement for the services they deliver.