Insurance companies are more and more shrinking reimbursement to physicians. Unfortunately this is out of the physicians control but there's hope. Physicians and medical insurance billers need to be more aggressive and in turn they will be more successful in collecting payment from insurance companies and patients that is owed to them. There are two aspects of revenue being decreased. First, claims are being denied by insurers and some claims are not resubmitted after a denial, or if they are resubmitted, they are past the allowable date. Generally, about 7% to 15% of claims are denied by insurers.
Second, because of these hard economic times, patients are simply not paying their bills. A study showed that 40% to 50% of patient balances are not being paid. This is sometimes due to high deductible health plans and the rise in people losing their jobs.
Most physicians have mastered their specialty but didn't realize that they would have to become business owners and also would need to learn the billing part of their business.
Physicians should compile a spreadsheet that shows each month's accounts receivable compared to the prior months. It should also list the date of submission of all claims and the number of denials each month. The number of denied claims resubmitted and the time that it took to resubmit the denied claims.
Offices that employ an onsite biller can delegate this responsibility to this person; or even better using an outside billing service they should be able to provide this type of report for you.
Start with denied claims
Some of the most common reasons a claim is denied is problems with eligibility and benefits verification. This should be verified EVERY time a patient comes in the office, even if it was the day before. Anything can change and it could mean losing out on revenue. Some other reasons are miscoding, duplicate submissions, transposed or missing numbers and billing the secondary insurance plan instead of the primary plan.
Improve the way patients are checked in during the registration process. It may take a little more time but the form that patients fill out when they are new or returning should be thoroughly gone over with the patient to verify everything is correct. On the patient registration form at the top should be an expiration date of the form that should be re-filled out after at least a year. Changes happen in people's lives everyday; divorce, new insurance, new job, change of address, change of phone number and all these things can affect your claim and could lead to a denial.
In the following article we will continue to discuss ways to collect and how to avoid denials from insurance companies. Collecting from patients will be the next subject we discuss in detail.
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