Practice Management Alert
Neglected-Claim Follow-Up
New Jersey Subscriber
Answer: Sort your outstanding claims by dollar amount and by payer. Focus on the larger dollar amounts first. Then, figure out why the money hasnt been collected. Is it uncollected because the insurance portion was never paid or because theres an unpaid patient balance?
If the insurer hasnt paid the claim, you may be faced with a timely-filing problem. Its possible the claim was filed, but the insurer never received it or lost it. Because no one ever followed up on the claim, you have no way of knowing whether the timely filing was met initially. Your computer system may not be able to track whether timely-filing limits were met on old claims. Claims with dates of service past the timely-filing deadlines probably will have to be written off. But, before you write off those claims, contact the insurer, explain that you were not with the practice at the time the claims were filed, and ask if you can resubmit them.
If you have claims unpaid by the insurer that are within the timely-filing limits, refile those claims immediately.
For accounts with patient balances, make sure the insurers have paid before you pursue patient payment. When youve verified that the insurer has paid its portion, go ahead and collect the patient balance.
Another issue is how much time you have to devote to collecting the 2-year-old money. If you are short on personnel, consider hiring a temporary biller to sort through old claims, refile ones that can be resubmitted, follow up on them, and collect patient balances. By spending some money for the extra temporary help now, your regular staff can keep up-to-date on their new work, and the temporary staff can increase your revenues by collecting on the old claims.
Show your physicians the money theyve lost by neglecting claim follow-up to illustrate the value of hiring the right people to do the job.
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