I know, looking at those numbers is your A/R report makes you feel a little sick to your stomach, right? Don't worry, we can get it under control and get it collected. I'm even going to tell you exactly how to get it done. Ready? Here we go...
1.) EOBs first.
First and foremost, you've got to get those EOBs entered. Only have a few? Great. Get them entered so you are dealing with as close to current information in your A/R report as you possibly can. Have a large backlog? Start with my article on backlogged EOBs here. Either way, get those babies entered. You can not tackle A/R that doesn't reflect accurate data.
2.) Sort by payor, your biggest first. Modified by timely filing deadlines
It make sense to start with the one with the greatest reward, right? So, start there. Adjust this if another insurance company has a shorter timely filing deadline. For example, if Medicare is your biggest payor and Aetna is your second biggest but has a 90 day timely filing deadline, you probably want to start with Aetna. You have a year with Medicare, so you have a little more wiggle room. Then go back to the Medicare claims that are nearly at a year and tackle those. Work forward from there.
3.) Resubmit unpaid claims.
If, after you've entered EOBs, you have claims that are unpaid and do not have an EOB, resubmit them. Or, when in doubt about an unpaid claim, resubmit it. Don't call, don't mess with it, just resubmit it. Why? Because sometimes insurance companies "lose claims" or mysteriously don't receive them. Miraculously they might receive it the second time. (Can you sense the sarcasm here? We all love submitting claims only to be told by the insurance company that they "never received it". ) Resubmitting all the unpaid claims is a little like shaking the apple tree. Yes, you will have a bunch that won't get paid and you will need to do some action to get them paid, but you will also have a percentage that simply get paid this time.
4.) Don't forget your clearing house denials.
You'll have plenty of EOB denials to deal with but don't forget the denials the clearing house kicks back. These are especially important because none of these claims have even made it to the insurance company yet. You are still "on the clock", as far as timely filing goes. That said, these can sometimes be the easiest ones to fix and get paid. I've seen claims sit there and all the needed was a bit of missing information filled in and then all of that patients claims can be submitted and paid. Amazing that thousands of dollars can sit there unpaid all because someone forgot to enter a birthdate or fill in box 9a.
When it comes to dealing with insurance companies, organization is your friend. So, use the above to organize your attack and then get after those claims.
As always, we are here should you need assistance!
Jessica Rose Greenwood
Jessica is the owner of JMK Billing, a Billing Specialist and expert in office management