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Collect on Unpaid Claims
Many facilities and medical practices have a number of denied insurance claims that are not actively being addressed. Because most billing departments focus mostly on the claims that are easily reimbursed, thousands of dollars are left uncollected.
Getting paid on old claims can be challenging so we put together a list of best practices to help you collect the money you deserve. These tips will sharpen your current billing practices, prevent future claim denials, and help you collect outstanding receivables.
Review Follow-up Procedures
It is critical to consistently follow-up on denied claims. When an insurance representative gives you a 15 day claim turn-around time, check back in 15 days.
Check EOB Denial Codes
Coding requirements vary by payor. The EOB denial code should tell you why a claim is denies. Reference the AMA Coding Guidelines or medical billing forums if the insurance company does not provide you with the information you need. Also keep a "code denial" spreadsheet. If multiple claims deny for the same reason so you can easily recognize trends.
Check for Typo's
Typo's in the patient's name, date of birth and address can all cause claim denials. If there is an error inputting the patient's info into the system, then each claim will deny until the issue is fixed. This will not show up on the EOB so if you are struggling to identify the reason for your claim denial, verify that the patient information is correct. We recommend that you make a copy of every patient's insurance card and photo ID at time of admission.
Medical Record Submission
Insurance companies are requesting medical records more frequently than ever before. It is best to send the records with a copy of the insurance letter but if that is not available, include a cover letter with the medical records.
Medical Record requirements vary by payor. Some insurance companies request a fax or hard copy sent by mail. It is becoming more common for providers to submit medical records through the online payor portal.
It takes a dedicated team to stay current with payor guidelines. We want to help you succeed!
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