What is an electronic claims submission? Discuss the advantages and disadvantages of electronically submitted claims. Be sure to include issues of error, privacy, and cost effectiveness
What will be an ideal response?
Answer:
All healthcare claims are submitted electronically to insurance carriers. These claims are called electronic claims. Electronic claims submission is a process whereby insurance claims are submitted via an electronic data interchange (EDI) directly from the provider to the insurance company. The Administrative Simplification and Compliance Act of 2001 (ASCA) started requiring Medicare claims to be submitted electronically beginning January 2012. The Health Information Technology for Economic and Clinical Health Act of 2009 (HITECH) also requires healthcare claims to be submitted electronically for standardization of the insurance billing process.
Claims submitted electronically usually contain fewer errors because they eliminate the need for data entry personnel to reenter the information, and payment is generated more quickly. In addition, insurance carriers reduce their management and overhead costs.
From the provider end, electronic claims submissions are performed on a routine basis. The medical biller reviews the claims ready to submit and sends them to the insurance company via the insurance company portal (EDI). Because electronic claims submission does not allow the opportunity for the physician to sign the claims, a physician's signature on the agreement with the insurance company is accepted in lieu of a signature on the claim form. It is imperative to also have the patient's signature on an Authorization to Release Information and an Assignment of Benefits form in the patient file. In both of these cases, indicate on the claim form signature lines "authorized signature on file."
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