We have designed our A/R Follow-Up in such a way that it increases the Revenue Collection for Physician offices. This part comes into action once the Health Insurance Claims (Electronic/ Paper claims or Manual HCFA forms) are submitted to various Insurance companies. Depending on the transmission type and length of time since submission we begin our follow-up:
Electronic Claims: Follow-Up begins after 15 days of claim submission
Paper/HCFA Claims: Follow-Up begins after 30 days of claim submission
There are two types of claims Follow-Up:
· No remark claims: Any claims in which absolutely no status is known for the claim.
· Last remark claims: Any claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis. The reasons for rejections include:
– Authorization Issues
– Referral Issues
– Medical Necessity and Medical Records requests
– Non-Participation with Insurance Network
– Terminated Insurance
– Coordination of benefits
– Wrong Diagnosis
– Inclusive Procedures
– Partial Payments
– Out-of-network claim status and deductibles
– EDI Rejections
– Letter of Protection from Attorney cases
– No status and No claim on File
– Workers’ Compensation
– PIP cases
The Follow-Up process is divided into 3 methods:
· Online Claims Follow-Up – Using various Insurance company websites and internet payer portals we check on the status of outstanding claims.
· Automated Claims Follow-Up (IVR) – By calling Insurance companies directly an Interactive Voice response system will give the status of unpaid claims.
· Insurance Company Representative Call– If necessary, calling on telephone an Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.
Once the Follow-Up process has begun Denied Insurance claims will require extra effort for resolution. Denials management is divided into two categories:
· Claim Correction and Resubmission: These are the claims which are corrected, modified, and resubmitted as a corrected claim to Insurance companies. For such claims every effort is made to resolve the denial to avoid billing the Patient.
· Patients’ responsibility: These are claims which cannot be further worked upon and the final bill is sent to the patient for payment collection. The reasons for sending the patient a bill generally include In-Network deductibles and non-covered benefits as per the insurance plan/policy. Patients will receive a statement with a clear explanation for the balance due.