Timely, accurate, and full reimbursement is the most important metric for keeping the lights on at your practice. But only around 70 percent of claims submitted are processed and paid on the first submission – leaving a whopping 30 percent unprocessed, returned unpaid, or requiring additional energy and time from your staff for resubmission.
Are you doing enough to make sure you’re always paid what you deserve? Follow these quick tips to get paid in full more efficiently.
File Claims Daily
Getting payers to reimburse you in full is challenging enough. Don’t let timely filing ever be a reason for denial! If you only dedicate one to three days of the week to filing claims, they can pile up much more easily than you realize.
Never let a stack of claims turn into a payment issue. Make it a priority for your back-office to always file claims daily.
Collect Co-Pays at Time of Service
As a billing company with 30+ years experience we’ve said it before – any and all unpaid balances hurt your revenue. Those $15 or $30 patient co-pays may not be top of mind when you think about your reimbursements, but they’re just as critical to your balance sheet as any other payments you’re owed.
Check in advance for what co-pay you’re owed by each patient at the time of service and make it an office policy to collect in advance of the visit. Have your front desk staff escalate any issues with patients who regularly refuse to pay up.
Update & Verify Patient Insurance
We know: Patients (especially those that are frequent visitors to your office) hate to dig up and hand over their insurance cards every time they come in. But making sure that there are no changes to a patient’s insurance is the only way to make sure that you handle things appropriately with their insurer.
And conducting eligibility checks may be becoming passé in some specialties, but we’re firm believers in verifying each patient’s coverage in advance of the encounter. It only takes a few minutes to verify insurance, but unpaid claims down the road could take you months to collect.
Track & Follow-Up on Unpaid Claims
Are you keeping track of submitted claims and tracking how long it takes for them to be paid? You can’t just sit back and expect timely, accurate payments to come in to your office regularly. Knowing what you’re not being paid for is just as important as knowing what you’re being paid.
If a claim takes longer than sixty days to be paid, follow up before you resubmit. Sometimes all it takes to get your claim handled by a payer is a phone call.
Make Friends with EOBs
Scrutinizing all explanation of benefits forms can be a smart way to spot unnecessary payer downcoding, bundling, or denials. Assign a staff member to compare EOBs to payments, and don’t let any of the forms slip through the cracks.
Or, consider working with a medical billing company that has the bandwidth to pay close attention to EOBs and the expertise to follow up appropriately with the payer. Getting paid properly may require persistent follow-ups; outsourcing to a medical billing service can take the time and effort of that task off your office’s hands.