Quick Tips for Claims Follow up

Resolving outstanding claims is crucial to improving your practice’s bottom line. Keep these tips in mind to take the pain out of claims follow-up.

1. Use payer websites, whenever possible, to check claim status and eligibility, search for payment policies and coverage criteria, and submit claim corrections and/or appeals.

2. If the claim is outstanding, verify whether it has been received. This is a good time to confirm that the patient’s coverage is still active: Some plans can retroactively terminate.

3. If the claim has been received, make sure that it is being processed. Get an estimate of when it should be processed, and make sure that no additional information (e.g., medical records, information from the patient, an explanation of benefits, etc.) is needed to complete processing.

4. If the claim is not received, verify the billing address and see if the claim can be resubmitted electronically or by fax. If resubmitting to the same address, send the claim by certified mail, to ensure proof of timely filing.

5. If an outstanding claim has been processed, find out if it was denied, or applied to the patient’s responsibility.

6. Establish a process for contacting patients, to request information on behalf of their insurer. You may wish to create a template letter for commonly requested items, which then can be drafted quickly, as needed. Attempt to call the patient, and advise him or her that you will be mailing a letter, as a reminder. Establish a time limit for patients to respond to your request (e.g., 10 days), and notify them that they will be billed for the full amount of their charges if they fail to follow through.

7. If the claim has denied, gather as much information about the denial as possible. For example, if the denial states “non-covered service,” you should know why it’s not covered. Is the service always excluded from coverage, or is there something about the way that it’s been billed (e.g., the diagnosis, or the patient’s age or gender) that caused the denial? Is the denial limited to the patient’s group or plan, or is it a company-wide coverage policy? If possible, try to locate relevant coverage information, in writing, to guide you.

8. Submit corrected claims and appeals within the appeal deadline, for each payer. Always clearly mark corrected claims and appeals, so that they are distinguishable from new claim submissions; otherwise, you’ll receive a “duplicate claim” denial.

9. Record your efforts to follow up on claims, including the name(s) of people you speak with, and the contact date and time. Note specific information relayed to you and any actions that you take (such as re-filing the claim, or verifying eligibility). This will help you to recall information if you need to address the claim again.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 402 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

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