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.