Know your objectives:

  • Proven techniques for following up on claims timely
  • Collection Calls that make an impact
  • Documentation is important, use detail

Top Dollar AR Accounts

  • Become familiar with the contracts
  • Know the payer timely filing limits for denials and resubmissions
  • Always work the highest dollar and shortest timely filing limit accounts first

Effective Collections

  • Work denials, follow ups and collections daily
  • Assign a collection specialist by payer
  • They become a specialist on that payer and should know the contract
  • Collection work in CPR+ can be done many ways. Ex: AR Manager, using Collection Note Follow Up reports, and Denial reports to name a few.

Design Timely Follow-up

  • Is a follow up phone call being made within 30 days?
  • Utilize the feature in CPR+ to be timely with follow up and eliminate out of control AR.
  • Insurance Setup/SPM
  • Tab 11+
  • Setup Options (F5) #17
  • Create Billing Follow Up Note with Due Date in # Days.
  • Set this to 30 days (depending on how quickly your payer sends remittance)

So you’ve been denied – where do you start?

  • Review the original claim
  • Was the all the information on the original claim correct?
  • Are your insurances and SPM (Special Price Matrix) set up correctly?
  • Correct Units and date (spans)
  • Every payer is different and may be set up differently or needs to be…KNOW YOUR CONTRACTS!!

Payer Website can assist

  • Utilize the Payers Websites to pull up explanation of benefits, shows payments, processing claims, denials etc.
  • Some of these internet programs are:
    • IVR (automated telephone)
    • CSI (Claim Submission Inquiry)
    • Navinet
    • Emdeon (WebMD)

Collection Calls that make an impact

  • Make sure you have all of the pertinent information available before make your phone call
    • Patient ID number
    • Provider NPI, Tax ID or Provider number
    • Patient Name
    • Patient Date of Birth
    • Date of Service
    • Billed Amount

Documenting your efforts and results

  • Utilize the billing notes for each invoice
  • Include details:
    • Who you spoke to, from where and when
    • What action are you taking
    • What correction is being done and by whom
    • What action are they taking
    • When will you follow up again

Share Information

  • If you obtain new/different information necessary to be paid for a service or product, share this information with:
    • Intake dept
    • Supervisors/managers, billing specialist
    • All personnel who needs this information to better perform their jobs
    • This will help with clean claim submissions and less collection on the back side
    • Provide training to staff if necessary

Recap

  • All collection work can be done in the AR Manager in CPR+
  • Work high to low dollars accounts first
  • Be aware of the timely filing limits for resubmissions and denials for your payers
  • Know your contracts
  • Make follow up calls within 30 days
  • Document your work in billing notes
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