Choosing how to bill insurance.

Three ways to get claims paid

Every practice that takes insurance has someone doing the same work: turning signed visits into claims, sending them, reading what comes back, fixing what was denied, posting payments and telling the front desk what each patient owes. The choice is who does it, and how you pay for it.

• In-house. Someone on your staff, often the office manager or the front desk between patients, works claims in your EHR’s billing module and sends them through a clearinghouse. You pay a wage, the clearinghouse and the hours nobody tracks.
• A billing company. An outside firm does the same work, usually inside your EHR, and is usually paid a share of what it collects.
• A billing service run on software. A service pairs people with software that handles the routine steps, often for a flat monthly fee, and shows you each step as it happens.

None of the three is right for every practice. A solo chiropractor with a light insurance mix and an experienced office manager can bill well in-house. A growing practice with three associates and six payers often cannot, because the claims outgrow the hours of the one person who knows the payers.

What decides it

Price matters, but four other questions decide whether a setup works for your practice:

1. How much insurance work is there? Count insurance visits a month and the payers they go to. Each payer adds its own rules, portal and enrollment.
2. Who has the time, and who covers for them? One person billing part-time with no backup is a single point of failure. A vacation or a resignation stops the claims.
3. Who reads every remittance? Filing is the visible work. Reading each remittance for underpayments and denials is the step most likely to be skipped, and it is where underpayments hide.
4. Who owns the accounts and the records? Your clearinghouse account, payer portal logins, enrollment profiles and the bank account payments land in should stay in the practice’s name, whoever bills your claims.

The cost you see and the cost you do not

Every setup has a visible cost: a wage, a percentage, a monthly fee. Each also has a cost that never shows up on an invoice: claims that aged past the filing deadline, denials nobody appealed, payments below your contract rate posted as if they were right, deductibles never billed. That second cost can outweigh the first.

So compare setups on what your practice collects, not only on what it pays. A cheaper option that collects three percent less of what you are owed can turn out to be the expensive one. The five numbers that show whether your billing works measure that second cost, whoever does your billing today.

An order of work

1. Measure where you are. Pull the five numbers for the last six months.
2. Price each option against your own volume. The guide to what a billing service costs works through a percentage, a per-claim fee and a flat fee for the same practice, and prices in-house billing the same way.
3. Ask the questions a proposal leaves out. Who works your claims, where your money lands, what you see each month and how you leave: questions to ask before you sign.
4. If you change, plan the switch. The claims in flight on the day you change are the ones that get lost: how to switch without losing claims in progress.

Where Claims Native fits

Claims Native is a billing service run on our own software. We do the billing work; your practice sees each step and gets back paid claims. For a practice billing up to $10,000 a month in insurance charges, it costs $500 a month, plus one launch fee quoted with your scope. Claim corrections, payer follow-up and appeals, payment investigation, insurance reconciliation and posting into your EHR are included. Cleanup of older balances and patient collections are priced separately. After the launch period it runs month to month, and your records leave with you.

Your current biller keeps working while we prepare and check every claim beside theirs. Each week you see the comparison, and your office and your provider decide when we start filing. See how we start.