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 these steps listed below, to increase the chance of receiving claim payments on time.
1. Verify the Payer Received and Accepted the Claim After Submission.
Check for claims that did not transmit and resolve promptly.
2. Check No Response Claims.
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, investigate why:
Ask about claim decision/payment status.
If additional information is required, obtain all details and submit accordingly.
Document the call, action to be taken and schedule follow up according to the promised due date.
3. Review Payer Decisions and Payments According to Payer Contract.
Appeal underpayments and inappropriately denied claims. Bill and collect patient guarantor for balance. Evaluate how quickly patient balance accounts are closed. Refine the workflow for best efficiency.
4. Follow Up and Follow Up.
Follow up. It is imperative to stay vigilant in the follow-up process and Implement workflow processes to maintain healthy accounts receivable ratios.
Efficiency, persistence, and timeliness will send messages to payors and patients that your practice is vigilant in collecting payments.