1.2.15 Issue #669 info@mckenziemgmt.com 1-877-777-6151 Forward This Newsletter

Nancy Caudill
Senior Consultant
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Insurance Payments ASAP
By Nancy Caudill, Senior Consultant

There are at least three methods of payment from insurance carriers that you submit claims to: direct deposit, paper checks in the mail, and debit card numbers. My payment of choice is the old fashioned paper check with an attached EOB. I have control over when the payments are posted and I don’t have to print the EOBs for my records. What holds up these payments from coming to your office? Let’s review the following reasons and recommendations to avoid these pitfalls.

Inaccurate Information: Patient and/or Insured
A claim is rejected instantly if the demographic information for the patient or insured is not accurate. This means the first and last name of the patient and/or insured must be spelled correctly, the ID or social security number must be accurate, as well as the group number of the plan. In addition, claims may be rejected due to the relationship being incorrect.

How will you know if the information is not accurate? In some cases, the software program you use will notify you of missing information. The clearinghouse that processes your electronic claims will also notify you if it catches inaccurate information (another reason to process claims electronically) OR you make a phone call to the carrier to inquire on the payment status of the claim. Their response will probably be, “We never received it” or “We have no record of it.” Either way, bad news!

Inaccurate Information: Treatment Procedures
A claim with an inaccurate dental code will stop the payment process. It could be a clerical error where the code was incorrectly entered or the procedure code itself was incorrect. I have seen claims submitted with outdated dental codes from several years ago. This is another reason to submit electronically, as they are often flagged during the process and can be corrected in the office.

Lack of Narratives to Describe Why Treatment Was Performed
Avoid waiting until you get a request from the insurance company for additional information relative to the treatment. Be proactive and submit the information initially when the claim is created. You can create a checklist of the various reasons why treatment is performed and have the assistants check the reasons chairside. This form, along with the routing form, is brought to the Scheduling Coordinator so she/he is aware of the treatment that was performed, as well as which narrative to add to the claim.

Lack of Necessary Digital Attachments
With digital information, sending attachments along with the claim is easy. “A picture is worth a thousand words” is still true, even in the insurance world. Along with a well-written narrative, the attachment says it all.

I was in an office recently and the doctor asked me why managing the insurance claims was so time-consuming. He asked me, “Don’t they just push a button and the claim goes out and the money comes in?” We could only WISH it was so easy.

For our McKenzie Management clients, we monitor the amount and the number of claims unpaid 60 days and over. The goal is to have zero! Yes, it is possible. To make it happen, however, you must start following-up at 15 days past due if the claim was processed electronically. If you wait until 30-45 days past due and discover that the claim was never received, the claim must be re-filed and it will not be paid by 60 days.

It takes time to stay on top of the unpaid claims. Insurance carriers don’t make money paying expeditiously. Some are governed by the Insurance Commissioner regarding the time spent processing the claim and some are not. Take it upon yourself to run the “Outstanding Claims Report” at the first of the month after the month is closed and then count how many claims you have to follow-up with that are 15 days and older. Divide the number of claims by the number of days that you work and this will equal the number of claims you need to contact each day. Remember to enter your follow-up notes in the Claim Status area for reference, should the claim remain unpaid the next month.

Run your Outstanding Claims Report for claims 60 days and over and see how many you have. You may be surprised!

If you would like more information on how McKenzie's Consulting Coaching Programs can help you implement proven strategies, email info@mckenziemgmt.com

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