For wellness practices that accept insurance, the lifeblood of the business depends on submitting insurance claims and receiving reimbursements. Closely managing this cycle ensures that the business can continue to operate in good financial health.
As many wellness professionals choose to manage their own claims processing, having best practices in place to keep track of claims is essential.
In this article, we cover the basics of managing your insurance claims for wellness services, including ways to save time and streamline your process. Learn how to submit, track, and follow-up on all of your created claims in an efficient manner.
1. Submit all insurance claims electronically
If you’re still sending paper CMS 1500 claims, the first step to streamlining your billing process is to switch to electronic filing. Electronic filing gives you an immediate record of your claim, along with real-time updates to your claim status. This digital trail of paperwork is critical in managing your claims.
Having to manually track paper claims, and manage resubmitting denied claims can add several weeks to your accounts payable cycle. Simply making the switch to electronic filing will immediately make managing insurance claims quicker, easier, and more efficient.
2. Use a clearinghouse
Clearinghouses are essentially electronic stations or hubs that allow healthcare practices to transmit electronic claims to insurance carriers in a secure way that protects patient health information, or protected health information. Additionally, clearinghouses offer medical billers and billing managers a way to consolidate all their electronic claims and manage them from a single location, from an online dashboard control panel, similar to online checking.
If you’re in-network with several insurance payers, and are using different payment portals to submit your claims, it can be time-consuming to track your claims status. It requires you to sign-in to each electronic portal, and review your claims, for each portal. You’ll then need to match up the claim reimbursement with your banking data, to ensure you’ve received the correct reimbursement amounts.
The beauty of using a clearinghouse is that you can submit claims to multiple insurance payers through one portal. This makes it easy to see an overview of all the claims you’ve submitted. To make claims management even easier, you can use a clearinghouse that integrates with your EHR/practice management platform, which allows you to see claims details directly within your EHR.
Furthermore, clearinghouses provide a way to “scrub” claims prior to submission — which does a systematic check for errors, and decreases claims denials.
3. Enroll in Electronic Funds Transfer (EFT)
One pain-point in managing billing claims is keeping track of reimbursements. After you’ve submitted a claim, you want to be sure that you’ve received reimbursement and for the correct amount. Most insurance payers today offer Electronic Funds Transfer, which allows for reimbursement funds to be deposited directly into your bank account.
Enrolling in EFTs provides healthcare professionals with:
- Quicker claim + payment processing
- More convenient, no need to physically deposit checks
- Easier record keeping, quickly compare your EFT to your ERA to verify correct payments
4. Block off consistent time in your schedule to manage billing
For wellness professionals who are managing their own practice, including admin work like billing, it can be difficult to set aside the time to manage claims. Staying on-top of claims, reconciling received payments, and resubmitting denied claims is a process — and this process needs to be done consistently to be effective. If you’re juggling between seeing clients and doing admin work, it can be helpful to block off your schedule regularly for claims management. Whether it’s once a week or once a month, have a regular set time to dedicate to this task. This will prevent any claims, or payments, from slipping through the proverbial cracks.
As a best practice, here is a quick checklist of items to review:
- Have all CMS 1500 claim forms for every client session been created?
- Have all created CMS 1500 claim forms been submitted?
- Are there any claims forms that have been denied, and need to be resubmitted?
- Are there any claims forms that have been processed? Are there any client-owed responsibilities to collect?
- Do all of the reimbursement details match payments I’ve received?
- Are there any outstanding invoices for clients to collect on?
One alternative to self-managing claims is to hire an office manager, or biller, to manage your billing work for you. For many wellness professionals, outsourcing this admin work allows them to focus on revenue-generating services, like client sessions.
5. Reconcile your financial reports regularly
At the end of the accounts payable cycle is receiving reimbursement for your wellness services or nutritional counseling. Insurance payers process submitted CMS 1500 claims, and ultimately issue you an Explanation of Benefits (EOB). The EOB explains what portion was paid to you as the healthcare provider and what portion of the payment, if any, is your client’s responsibility.
While this information may be stated on the EOB, it’s up to you to ensure that the correct amounts have been 1) collected from your client and 2) paid to you. Errors happen, and although the EOB may state that you’ve been paid XX amount, you’ll need to confirm by checking your banking statement. Reconciling these amounts is a critical step in the process, one that you’ll want to do carefully and diligently.
Tracking Insurance Claims in Healthie
Healthie is a practice management platform designed for nutrition and wellness professionals. With integrated EHR and insurance billing features, creating (and tracking) insurance claims is easy.
As you create and submit CMS 1500 claims through Healthie, you’ll want to keep track of statuses within the Platform. Healthie allows providers to keep track of statuses including: Sent, Not Sent, Reimbursed. If you’re part of an organization, you can also enable Healthie’s settings so that you can view and manage all claims across your organization.
Viewing Status of CMS 1500 claims:
Keeping Track of your CMS 1500s – On the CMS 1500s page (accessed through the drop down menu under “Billing” on your sidebar), you may track the status of your CMS 1500 by selecting “Sent,” “Not Sent” or “Reimbursed” for each CMS 1500 you have created.
- Sent: completed claims that have been submitted to the insurance payer
- Rejected: claims that have been denied by the insurance payer, which you may need to resubmit
- Not sent: claim forms that you have created, but not yet submitted to the insurance payer
If you use Healthie’s auto-integration with Office Ally, claim statuses will be updated automatically.
Running financial reports in Healthie:
In Healthie, running financial reports allows you to keep track of your claims and reimbursements/payments received. For insurance-based practices, consistently running the CMS 1500’s report gives you deep insight into:
- How many claims you have created (in a given date range)
- Client insurance information
- Segmentations by client, group, insurance
- Reimbursement amounts received for a claim
Want to learn more about Healthie’s insurance billing capabilities? Start your free trial today.
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