No matter how thorough your billing process is, every provider has a list of claims that seem impossible to get paid. Overturning claim denials can be a grueling process, but if you follow the 5 steps listed below, your outstanding claims list will disappear in no time.
Create a Plan
Start from the oldest outstanding claims and work backwards. Many payors such as United Behavioral Health have timely filing deadlines and won’t reprocess a claims after 90 days.
Make a List
Group the outstanding claims that need follow-up according to insurance company. This will save you time on the phone. It can take over an hour to speak with an insurance representative so you want to discuss as many patients at one time as possible.
If you have any outstanding appeals, follow the same protocol. Appeal letters are handled by a different department which means a separate phone call and more wait time.
Adjust Balances You Won't Collect
Once you review your aging report, adjust off any charges that you know you won't collect. Maybe the claim was denied correctly or the balance was applied to the deductible. Regardless the reason, if the claim won’t be paid you don’t want to keep following up on it.
Before you call an insurance company, review all of your previous claim notes. Gather reference numbers, document control numbers, the authorization number and any other information relevant to the claim in question. The stronger the case you can make for the claim, the more likely it is to be processed and paid correctly. By familiarizing yourself with the patient and claim history you will be able advocate more efficiently.
If you have to send a corrected claim or medical records, do not assume that just because you mail it, that it will be reprocessed. Insurance companies have a convenient way of “not receiving” documentation. Send your mail with a tracking number and keep fax confirmation letters. Furthermore, do not assume that just because the mail made it, that it is being processed. Consistent follow-up and thorough documentation is the only way to ensure that the correct action is being taken.
Set an Alert
The best way to stay consistent with follow up is to set a reminder on your calendar for each day that an action should finalized. You can alerts in some EMR systems and in all smart phones.