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
- 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)
- 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
- 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
- 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