Tag Archives: Rejected Claims

How Inappropriate Unpaid Claim Follow-Ups Affect Your Bottom Line

Following up on unpaid claims is a vital part of the collection process. But if you do it the wrong way, or with no sense of urgency, it can result in lost revenue or patients being confused and frustrated by your billing process.

Analyzing your collections process for inefficiencies, gaps, or missed opportunities can ensure you’re maximizing revenue and not making the process more difficult or complicated for your staff or patients.

Things to consider about your follow-up process:

Are your claims being received by the insurance company?

Unreceived claims occur most frequently with paper claims, so filing electronically can help ensure that those claims can be resolved more quickly.

Insurance Claim ProcessAre claims being denied or rejected?

There’s a big difference between denied and rejected claims. A denied claim states the insurance company has processed and deemed a claim unpayable.

Inquiring about the reasoning behind denied claims before you receive the rationale in the mail can help the matter get resolved in a more efficient manner. A rejected claim has not yet been processed because of a coding or some other kind of error.

Rejected claims can be fixed and resubmitted, while denied claims must be appealed and can take longer to process again.

Are you tracking outstanding collections?

Knowing how much money is owed to your practice at all times can help determine whether your follow-up process is effective.

Perhaps you’re not sending bills soon enough after a patient encounter, or maybe an electronic bill is more effective than a mailed one? Maybe you can change how you’re communicating with certain insurance companies?

Proper tracking can help identify process issues quickly, addressing them in a timely manner.

Are you monitoring for repeating issues with claims?

Patterns in certain claims that are being denied could actually be a problem on the medical practice end of the process, not the insurance company. One insurance company may have a different policy for number of codes allowed to one diagnosis or what codes are allowed for particular procedures.

Do the patient and the insurance company need to be in communication with one another?

Sometimes an insurance company requires information or documentation from a patient before they can process a claim. Bridging the gap between the patient and the insurance company can hasten the collection process.

Not being proactive about why a claim has been rejected, denied or is sitting in limbo can seriously impact a practice’s revenue. At Medical Revenue Associates, Inc., we encourage practices to have a thorough process that is constantly moving towards a paid claim in order to prevent a dent to your bottom line. Give us a call at 215-497-1001 if you have any questions about your unpaid claims or improving your follow-up process!