Practice Management Alert

Question: Our office still uses paper forms to file Medicare claims. The paper claims are often "lost" by the payer or take longer than our 30-day agreement to be paid. What should we do to correct this situation?

Oregon Subscriber

Answer: The most obvious answer is to convert to electronic payment whenever possible. Until then, most Medicare carriers have a staff to help you determine the payment status of a particular claim. When you call this number, make sure you have your Medicare provider identification number (PIN), the patient's ID number, the date of service, and any other pertinent information relating to the claim.

If the carrier says it has no record of receiving your claim, resubmit a new claim ASAP. Double-check the payer's mailing address, including post office box number and extended zip code against the one on your claim.

If the insurer says its records show the claim was paid, get the provider remittance notice number, the amount paid, and the date the carrier says it paid the claim. If the carrier says the check has been sent and cashed, request a copy of the canceled check.

If the claim has been held pending a review because of some question regarding the coding, amount or eligibility requirements, find out as much as you can about what is being questioned and when the review should be finished. Note the representative's name, and the date and time of the conversation.

Provide the carrier with any information it says is missing or questionable, then follow up to make sure they received it to avoid any further delays in processing the claim.