Anesthesia Coding Alert

Tip: Don’t forget to keep a check on patient balances.

Making time to deal with unpaid claims in the midst of day-to-day work can seem like a daunting prospect, but focusing on one aspect at a time makes the task manageable.

Remind yourself that your practice’s cash flow depends on your accounts receivable (AR), then prepare to follow this advice from Terry Fletcher, BS, CPC, CCC, CEMC, SCP-CA, ACS-CA, CCS-P, CCS, CMSCS, CMCS, CMC, QMGC, QMCRC, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California.

Begin by Breaking Claims Into Categories

You can’t map out your best plan of attack until you know what you’re dealing with. Begin your catch-up with a look at where each category of AR stands: 0-30 days, 30-60 days, 60-90 days, 90-120 days, and even the dreaded 120+ days, Fletcher says.

The ideal scenario is keeping your physician AR in the 0-30 day category, but you need a process and plan for when it inevitably trends toward the 30-60 day category.

It may be easy to tell yourself that those languishing claims aren’t a priority right now, but that’s dangerous. “That’s a dangerous way to approach claims because your denials will age out,” Fletcher says.

The middle of the road are the claims and denials in the 60-90 day category, and at this point some of your appeals rights have really passed you by, Fletcher says.

“Look at those contracts,” she says. “Some will only allow you to appeal within 60 days after receiving the payment.”

Top tip: Even if you’re strictly a coder and don’t work for billing or collections, you really are involved in billing because your coding choices directly affect revenue. “You need to be available to your billers and your collectors should they run into pended claims or processing issues where the codes don’t match, aren’t linked, or that is the reason for the pended claim,” Fletcher says.

Pay Attention to the Contracted Rules

Once claims reach the 90-120 day range, you’re passing timely filing deadlines. “Oftentimes insurance companies drop claims in the same batch as others,” Fletcher says. They’ll pay a majority of the claims but miss a few other dates of service, which can be a delay tactic.

“If you continue to ignore those unpaid and nondenial claims — if you don’t catch them, a majority of payers will say you didn’t send the claim to them in time per your contractual agreement,” she warns. “You can try to appeal using your clearinghouse proof of claim sent, but sometimes just the cost of the appeal may not be worth it, based on what you may be paid.”

The claims that are older than 120 days are really there to roost, Fletcher says. Don’t let your practice have money that is sitting there because then you’re looking at a cashflow emergency.

Keep Tabs on Patient Balances, Too