Electronic claims and attachments

By Tom Limoli, Jr.

Our future is in the hands of the young. Like it or not, our children will technologically surpass any and all expectations of our past.

While in the midst of a "prewinter cleaning," I found in the attic several stacks of computer keypunch cards. I momentarily reminisced about the many hours and nights I spent in the computer laboratory entering formulas and data that were later fed to the University of Georgia's "supercomputer." (For those of you who have no idea what I'm talking about, one card holds only 80 characters, while a 3 1/2-inch disk holds 1.44 megabytes of data.)

These relics of my undergraduate statistics curriculum will soon be kindling in the fireplace. In that same box, I found my trusty Texas Instruments SR (slide rule) 10 calculator. It carried me through high school algebra and trigonometry, as well as my freshman year of college. These aging implements of technology were at one time considered benchmarks of analytical progress. Who would have dreamed that technology would enslave the few while bewildering the many?

So, tell me — what are you doing with that old amalgamator? How about that molten metal sterilizer? When did you do your last gold foil restoration? Why are you still not submitting your claims and attachments electronically?

1. It costs too much.
The average cost of an electronic claim is between 35 and 60 cents. Many insurance companies and third-party administrators are paying the bill for you, and claim-filing with these carriers is free. By the way, did you know that the administrative cost in your office to produce and mail a paper claim and duplicated radiograph is approximately $4? Let's see, 50 cents or $4? Which will it be?

2. My software vendor says that not all claims can be transmitted and/or processed electronically.
This is not true. A high quality "all-payer" vendor can accept all the claims and encounter forms from your office and forward them to the appropriate payer. In many instances, you needn't be locked into the claims-processing vendor chosen by your practice-management software. You want the freedom of choice to select a vendor.

3. I have no computer and/or Internet access in the office.
Ten percent of dental offices still are not automated. These are simply the remaining, bewildered few. As for Web access, yes, your administrative team needs access to efficiently process and transmit electronic claims and attachments. Benefit information and financial arrangements are more easily accessible.

4. I don't want to deal with a claims vendor. I want to go directly to the insurance company.
Then, go for it. Many of the nation's major payers are currently provider-direct through the Internet. Direct payers can be accessed through any standard or high speed ISP.

5. I still will have to send X-rays and perio charts.
Don't fall into the trap of separating claims into electronic and paper. You are shooting yourself in the foot. Payers will continue to request radiographs and perio charts from you until they are satisfied your claims are clean and straightforward. Once this probationary period has passed, your office will most likely be placed on an "attachment-free" status. This means the payer only will request one or two X-rays a year, and reimbursements will be generated to your office in seven to 10 business days in most cases. If your office does not complete or successfully pass the probationary period, you will continue to be required to send radiographs and perio charts.

Now is the time to get off the stick. As of October 16, HIPAA mandates that all payers be able to accept electronic attachments. As for the old argument of "covered entity" vs. "noncovered entity," the door is rapidly closing. If you treat patients, congratulations! You soon will be a covered entity.

See you on the road!