You have a new EHR and you’ve gotten the hang of charting.
Now you are ready to set up your billing process.
Here are 7 steps you want to follow to ensure your transition to billing with your EHR is successful:
1. Have an internal meeting to discuss what services need to be added
These would be services you perform for a client.
Examples are:
- Immunization
- Vaccine List
- Blood Draws
- Tests
- Etc
If providing Medicare Certified Home Care, the list will be more extensive.
In short, anything that is billable should be included on the list. Your Public Health Billing Manual provides a list of potential services.
2. Create a list of payers that you will work with
Some examples include:
- Insurance companies (be sure to list individual insurance companies, such as Aetna, BCBS, Sagamore, etc.)
- Medicaid
- Medicare
- Worker’s Compensation
- Veterans’ Administration
3. Research each of the payers to determine whether they have a web portal you may use to submit electronic claims
Ultimately, you will be making the decision whether to file direct to a payer or send claims through a clearinghouse.
*HINT: The key will be to keep your claim submission process as simple as possible, without incurring any unnecessary expenses. If you are unfamiliar with clearinghouses and how they may benefit you, there is an article on clearinghouses that you may find helpful.
4. Establish a fee schedule for all services being offered
Guidance for this is available in your Billing System Manual.
5. Research any clearinghouses that you are considering
Sometimes there is an upfront start-up cost or a monthly fee to the Health Department to submit claims to a clearinghouse.
However, some clearinghouses are set up in a way that their contracts are with the payer, and therefore, the payer is the entity that will pay for claims submission.
You will want to compare carefully and negotiate the best deal possible.
Oftentimes the clearinghouse will waive the start-up fee.
6. In some cases, to save money, Health Departments will send some claims directly to a payer and other claims will be submitted through a clearinghouse
While this process may save some money, it will require more time and effort for the person submitting the claims.
7. Consider how you will check eligibility
If you don’t currently have specific eligibility software, you will need to check sources for this service.
Most third party payers provide website access to check eligibility. There is no cost to access these websites.
