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How to Stay Ahead of Collection Delays

Ensuring payment is just as important as submitting a clean claim on time. Payments are delayed for many reasons resulting in the need to collect more aggressively. This is key since the collection process itself now demands more follow up labor expended than it did in the past. One would think because of technology advances this would not be the case but it is. 
 
Consistently follow the four steps below to increase the chance of receiving payments on time:
  • Within 24 hours of submission, verify that the payer received and accepted the claim without error. Resolve claims that did not transmit.  
  • Check the status of the claim if no response has been received. Know the response time requirements of your major payors for claim acceptance and claim payment. If you have not received a response shortly after this time frame, begin additional action:   
    • Ask payor when payment will be sent.
    • If the claim is delayed, find out why and ask for a detailed explanation. If additional information is needed, provide it immediately.
    • Document the call, request a reference number, and set a follow up date or move claim to the next follow up queue.
  • When the payment is received, determine if it accurately reflects the contract allowance.
    • Call immediately to resolve an incorrect or denied payment.
    • Ask when the payment will be received if the issue is resolved.
    • Begin the appeals process promptly if no settlement is reached.
    • If the right payment is received and posted, transfer to secondary insurance (when auto crossover is not in place) or patient guarantor and bill for the balance on the same day.
  • Follow up on unpaid services.
    • For third party payors, contact on all outstanding balances at least every 30 days. Include workers' compensation, automobile and attorney claims in your follow up. Make it a best practice to check on all outstanding claims with that payor. 
    • Report any trends impacting delays to management. For example, the Medicare computer system experiences an outage for several days or the practice (or doctor) is not listed as a plan participant, etc.
    • For patient accounts, collect unpaid deductibles upfront if that is permissible by state law. That's because often, fees not collected in advance are never collected.
    • If possible, it is better not to allow payment plans for an extended time period. However, if your practice allows longer payment plans, advise the patients that the full amount is due and payable in the event of a default in the payment arrangement agreement. Depending on a patient's financial situation, you may elect to begin the plan with a lesser dollar amount and then increase the minimum payment after 90 days.  
    • Lastly, make sure your practice bills all patient accounts including those with payment plans, every 30 days.
It is imperative to stay vigilant in the follow up process! Efficiency, persistence and timeliness will send messages to payors and patients that your practice is vigilant in collecting payments. 

Success Stories


Average bill age when our office received: 180 days plus BALANCE: $ 1,233.00 PROBLEM: Claim denied needing primary EOB. SOLUTION: Claim billed to supplemental policy instead of MMAI policy which was effective for service date.
Average bill age when our office received: 180 days plus BALANCE: $ 2,176.00 PROBLEM: Claim denied because of no insurance coverage for service date. SOLUTION: Claim was filed to incorrect claims address.
Average bill age when our office received: 180 days plus BALANCE: $ 1,013.50 PROBLEM: Claim denied because of insurance ID mismatch. SOLUTION: Claim filed to traditional plan vs. community care.
Average bill age when our office received: 180 days plus BALANCE: $ 1,203.00 PROBLEM: Patient disputed charge/balance owed, comparing it to a similar past bill. SOLUTION: Explained itemized charges and balance owed because of deductible. Patient stated first time someone took the time to explain and set up a payment plan.
Average bill age when our office received: 180 days plus BALANCE: $ 1,007.50 PROBLEM: Denied by hospice as non-eligible benefit and Medicare as ID name mismatch. SOLUTION: Verified/corrected Medicare ID, name and date; confirmed hospice non-eligibility.
Average bill age when our office received: 180 days plus BALANCE: $ 1,305.00 PROBLEM: Denied no pre-authorization for service. SOLUTION: 3-way call with patient and insurance. No ER report on file when claim originally submitted. ER report since received.
Average bill age when our office received: 180 days plus BALANCE: $ 1,001.50 PROBLEM: Denied with "misrouted" and "claim not covered by payor". SOLUTION: 3-way call with patient and insurance. Claim was related to mental health so should have been filed through carve out policy.
Average bill age when our office received: 180 days plus BALANCE: $ 1,755.00 PROBLEM: No response from insurance after requested records submitted. Patient stated insurance paid. SOLUTION: Billing office did not receive/post insurance payment. Called insurance and records received but claims representative had not released for processing.
Average bill age when our office received: 180 days plus BALANCE: $ 4,540.50 PROBLEM: Multiple bills, same service dates as claims already paid. Denied due to no pre-authorization for service. SOLUTION: Call to insurance who verified no pre-authorization requirement. Two claims not found. To prevent duplicate denial upon resubmission, account rep notated resubmission for return transportation trip. Proof of timely filing submitted with claims.
Average bill age when our office received: 180 days plus BALANCE: $ 1,180.00 PROBLEM: Denied due to no pre-authorization for service. SOLUTION: 3-way call with patient and insurance. Claim should have been sent directly to IPA vs. umbrella insurance location.
Average bill age when our office received: 180 days plus BALANCE: $ 1,117.00 PROBLEM: Unpaid due to incomplete demographic information. SOLUTION: Contacted pick up and drop off locations. Sent release to obtain information and patient’s name misspelled.
Average bill age when our office received: 180 days plus BALANCE: $ 1,605.00 PROBLEM: Denied due to medical necessity. SOLUTION: 3-way call with patient and insurance. Spoke with multiple reps and received different answers including claim not found. Claim was found with no response from medical board. Patient had to submit medical records.
Average bill age when our office received: 180 days plus BALANCE: $ 1,007.50 PROBLEM: Denied multiple times as duplicate. SOLUTION: Located claim number ID, amount paid and date paid. Claim had already been paid in full but not posted.
Average bill age when our office received: 180 days plus BALANCE: $ 1,650.00 PROBLEM: No insurance on file. SOLUTION: Pick up location was state prison. Located inmate ID and could be billed to prison insurance as still within timely filing limits.
Average bill age when our office received: 180 days plus BALANCE: $ 2,295.50 PROBLEM: Denied as “forwarded to another entity for processing”. SOLUTION: Called insurance for medical group processing information. They did not have claim on file. Resubmitted with proof of timely filing.

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