Effective collections follow up is critical to the timely resolution of your behavioral health institution claims. All claims should be followed up on within 7 to 10 days of the claim being submitted to the insurance carrier. Pursuing quick payment of claims will not only cut down on time spent on accounts receivable, but it will also improve cash flow.
In order to have the most efficient revenue cycle management possible, you need a workforce that is well-versed in insurance reimbursement regulations, as well as negotiation and customer service. The capacity to have crossover knowledge in benefit verification and claim filings is a vital signal of a competent personnel.
Be well-prepared at all times. Make sure you’re asking the right questions by extensively researching the patient’s history. Once you’ve reached out to an insurance representative, you’ll want to have all of the information you’ll need on hand. The following are some key points to keep in mind:
It is critical to obtain as much documentation information as possible from the call. Once the call is finished, ask the customer service representative (CSR) the following questions:
When making follow-up calls on circumstances that may require more than one call, this is crucial.
However, if you can, attempt to collect this information ahead of time – carrier disconnections can happen at any time. It’s obviously easier to pick up where the previous call left off if you have a point of reference.
The “Ten Commandments of Insurance Billing Questions
The final goal is to determine whether or not a claim has been processed and whether or not a payment may be expected. It has been over a month since a claim was submitted, which is a crucial indicator that there may be a problem. If this is the case, the CSR should be able to explain what went wrong and how to fix it so that the claim may be handled. Make certain you’re asking enough of the proper questions. You’ll get closer to receiving reimbursement from the insurance company if you do this on every call. The “Ten Commandments of Insurance Billing Questions,” as I call them.
- Is there a problem with the claim, or why is the reimbursement process taking so long?
- What are they reviewing if the claim is still processing or “under review”?
How long does it take to hear back from an insurance claim?
Because physical damage and medical claims are more complicated, they can take a little longer. The amount of time needed to file a physical damage claim is determined on the extent of the harm. Within three days of filing a claim, you should hear from an insurance adjuster to discuss the situation. It could take a few more days if they need to survey the damage.
The process can be sped up if you utilize a repair shop that is linked with (or at least approved by) your insurance carrier. The simplest problems will be resolved in one to two weeks. Complex ones can take weeks or even months, depending on scheduling conflicts and the length of time your automobile is in the shop. You can, of course, drive your automobile until the repairs are finished if it’s drivable.
Depending on how complicated the claim is, medical claims can take a long time to process. After you’ve completed the first claim paperwork, it’ll be sent to the hospital and doctors, who will handle the situation directly with the insurance company and claims adjuster. If your health-care provider already covers you, you’ll need to file a separate claim (which is normally done by your health-care provider) to get your expenses paid. Of course, this will lower the amount you are able to recoup.
When should claim follow up be performed?
The easiest aspect of billing is submitting claims to insurance carriers. The more serious issue is securing payment. Knowing what’s causing the delay could be half the battle.
Keep Your Eye on the Clock
If you submitted claims in January and your aging report shows that several of them have yet to be paid, you have two options: either write the unpaid claims off as a loss or contact the insurers of the pending claims to find out what’s going on.
However, over a year has passed, and depending on the insurance company, you may be subject to time penalties. If an insurance requires claims to be made within 90 days, receiving any payout at this time will be practically impossible.
During the revenue cycle, it’s critical to follow up on claims. The aging report should be followed up on first. Every six weeks or every 30-45 days, do a primary aging report. This gives you enough time to investigate claims and submit resubmissions within the time constraints.
Troubleshoot Denials and Outstanding Claims
- Wrong information: Ask the covered patient or, in the case of hospitalists, the hospital for the right information.
- Insurance coordination of benefits: As part of the coordination of benefits, determine which insurance is main and how much the secondary insurance will pay.
- W-9: Before the insurance company can pay claims made by a medical practitioner, it must have a W-9 on file.
- If the medical professional is a hospitalist, get this information from the hospital or call the patient’s insurance company if the authorisation number is missing. Your office is responsible for obtaining an authorization for a service before it is given for Medicaid patients. You can submit an appeal letter with medical notes if there is no authorization number on file and the insurance company requires it to settle the claim. You won’t be able to bill the patient if the insurance company refuses the claim due to a lack of authorization; you’ll have no alternative except to write off the claim as a loss.
- The claim was sent to the incorrect insurance company; prompt follow-up can fix this mistake.
- Incorrect ICD-10 or CPT code: Coding errors are common since diagnostic and procedure codes change every year in October, after the ICD-10, HCPCS Level II, and CPT code books for the next year are released.
Beginning Oct. 1, 2016, the diagnostic code for Enterocolitis due to Clostridium Difficile was A04.7. A04.7 is no longer a valid diagnosis code as of October 1, 2017. Because two additional, more precise codes were added, submitting A04.7 will result in a denial:
If you keep using your current year code books beyond October 1, make careful to indicate mid-year code changes in them to avoid denials for code usage that is no longer valid.
Other causes for denials include: invalid patient name, invalid subscriber number, incorrect date of birth, incorrect date of service, incorrect location of service code, and so on.
Don’t Skimp on the Follow-up Process
It’s difficult to keep track of claims on a regular basis, especially when you’re juggling a lot of other responsibilities. That is why it is critical to be well-organized. If you keep your schedule organized, you’ll be able to fit this crucial chore into your timetable. Set aside some time at the end of the day or a specific day of the week for follow-up. Claim research can be done either online (usernames and passwords are necessary to access insurer websites) or over the phone with customer care.
Following up on unpaid claims thoroughly and on a frequent basis will result in less losses and more revenue. Your medical practitioner will be grateful for the extra time and effort you put into each circumstance.
What is a claim follow up?
You can track and address denials, track follow-up history, prioritize custom worklists of balance-due accounts, and simply see A/R reporting to pinpoint and rectify any difficulties using Claim-Follow up. This important billing feature aids in the collection of more income and the development of a more long-term medical practice.
What does an insurance follow up do?
An insurance follow-up specialist’s main tasks include managing hospital and physician billing and collections. This type of expert serves as a liaison between the medical facility, the patients, and the insurance company. They aid in the filing of insurance claims, the determination of write-offs, and the resolution of coding problems. They also look at policies to see what benefits are covered, file patient claims, and follow up on those claims.
What do you do when insurance company won’t respond?
If you don’t get a response, you should consider filing a lawsuit. Finally, if you haven’t received a response to your demand letter or other attempts to resolve your damage claim, you should check your state’s statute of limitations. A timeframe for filing a personal injury case in court is established by this statute.
Why do insurance claims take so long?
To evaluate culpability and liability, insurance firms may perform a thorough investigation into an accident. This is one of the reasons why insurance companies may take a long time to pay out. However, this isn’t the only factor that can delay payment.
Delays can also be caused by damage reviews, contested claims, or even abusive claim settlement tactics. According to ISC 2601, certain discriminatory insurance practices are illegal in New York. If you consult with a lawyer on your case, they may be able to fight for compensation on your behalf in a personal injury lawsuit or an insurance claim.
How do you process a claim?
Get in touch with your broker. When it comes to your insurance policy, your broker is your main point of contact; they should be aware of your situation and how to proceed. An adjuster will contact you to continue the claims process when you send your broker a thorough list of all the objects that were damaged or lost, as well as any images or videos that help to clarify the circumstances.
How do I check my claim status?
To withdraw money from your PF account, you must submit a request to the Employees’ Provident Fund Organisation (EPFO). The EPFO is a government-run organization that reports to the Ministry of Labor and Employment. You may not know the status of your request for PF withdrawal after you submit it.
To address this issue, the EPFO has implemented an online system that allows you to check the status of your request. To verify the status of your EPF withdrawal claim, follow these steps:
Step 1: Visit the EPFO website. Select ‘Services’ from the drop-down menu, then ‘For Employees.’
Step 3: When you click the link, you’ll be taken to the member passbook application.
Step 5: Select ‘View Claim Status’ from the drop-down menu. View the status of your claim by clicking on the same.