Claims processing goes high-tech

Practice cuts staff by using Internet service

In an era where a penny saved can be the only penny you are sure of earning, finding a way to get more money into your practice faster at a lower cost is increasingly important. One way to do that is to outsource some of your financial functions. But rather than send them to a local company, now you can send them through the Internet. One Portland, OR, pediatrics practice has done just that, saving one full-time staff position and cutting days outstanding for accounts receivable by at least a third.

According to Katherine Whitaker, bookkeeping supervisor at the 20-physician Children’s Clinic, accounts receivable were out for 60 to 90 days a year ago. "We really wanted to find a way to increase our cash flow," she explains. She and the practice administrator felt that number needed to get down closer to 30 days in order to ensure the continued financial health of a growing practice.

They checked with their computer and software vendors, local outsourcing companies, and their peers in the Portland medical community before finding an Internet claims service, Claim snet (, which offered flat-fee services. "We really made the choice based on price," she says.

Over the course of the year the practice has used the service, Whitaker says the days outstanding on accounts receivable has declined steadily and is now closer to 30 days than 90. During a period where the practice grew by four physicians, Whitaker only had to hire a part-time staff person to handle the increased workload. "Without the new system, I would have had to hire at least a full-time person, and maybe one and a half people."

The flat fee system at Claimsnet, based in Dallas, was certainly one of the main selling points for Whitaker. The program currently has about 2,400 subscribers, says chief operating officer Terry Lee. It requires no software or hardware purchase. It is all done through your Internet browser and costs just $25 per month.

For that fee, practices can process unlimited commercial claims. The fee also covers each practice site, rather than a specific physician. Medicare, Medicaid, and some of the Blue Cross/Blue Shield programs cost an additional quarter per claim. "We don’t get anything with them if filed electronically, so we have to charge that," explains Lee.

Statements are produced for 49 cents, including postage, return envelopes, and laser printing. "A physician practice would probably spend about a dollar on that," says Lee. Eligibility referrals are done for $30 per month.

Six standard reports provided

For another $10 per month, practices can get six standard reports:

• diagnosis and procedure code by gender;

• all patients by procedure code and geography;

• all patients by diagnosis code by geography;

• all patients by payer by diagnosis code;

• all patients by payer by procedure code;

• all patients by payer.

The next release of the Claimsnet program will include the ability to produce customized reports, too, says Lee.

The program also may cut down on denied claims because it will tell you immediately if a batch of claims contains any errors. While transmitting the clean claims to payers immediately, it will send the others back to the practice with a note on where the problem is — for instance, if the gender box wasn’t filled in or if you insert the wrong payer’s code.

Although this was another selling point for the program, Whitaker says she hasn’t seen any decrease in denied claims from the system as yet.

In the future, Claimsnet will offer a finance option that can perform credit checks, set up leasing and credit options for practices, and perform quality checks, says Lee.

Claimsnet is the only company out there. There are other Internet services that provide these and other services. Healtheon ( is one of them. But so far, Whitaker is very happy with the Claimsnet service.

"The program is really slick," she says. "And it’s more than paying for itself."