Practice Management Alert

Question: What should we do with suspended claims?

Michigan Subscriber

Answer: Most billing software allows billers to hold or suspend electronic claims that have incorrect or missing information, such as a missing diagnosis code or a code with too many digits. In such a case, check the patient's medical record to see if the proper code was recorded or ask the physician for the correct diagnosis code. To avoid sending the claim electronically until you make the correction, you should suspend it.

Holding claims for correction prevents you from wasting time submitting claims that will be rejected by the payer's editing software. When the payer's software "edits" a claim, it has found a data error and is tossing it back to you. By catching omissions and errors before you submit the claim, you can spend less time reviewing the payer's edit reports and resubmitting claims later.

You should implement policies and procedures to ensure prompt follow-up on the suspended claims. Include when it's appropriate to suspend claims, how soon the follow-up must occur, and when they should be sent.

You Be the Expert and Reader Questions were answered by Catherine A. Brink, CMM, CPC, principal of Healthcare Resource Management Inc. in Spring Lake, N.J.; Pamela Sharkey, CPC, CMM, administrator of Medibilling in Paramus, N.J.; and Elizabeth W. Woodcock, MBA, FACMPE, the Atlanta-based director of knowledge management for Physicians Practice Inc. of Glen Burnie, Md. $ $ $

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