Make Even Problem Payers Pay Up With These Tips From 2 Pros
Posted on 10. Aug, 2009 by Editor in Hot Coding Topics
Follow this 3-step path and get results from every payer.
At some point in her career, every biller deals with them. They are problem payers — and they can wreak havoc on your billing and on your practice’s income. Payment delays, improper denials, and claim rejection errors cause more work for you and can be a serious hurdle in getting the timely payment your physicians deserve.
Take heart. We’ve got some field-tested strategies two veteran physician billers have used to bring in the money for their physicians’ services.
Step 1: Research the Original Claim
Your first step when you discover that you have a problem with a payer is to do research. If you’re facing payment delays, find out why. If you’re receiving improper denials, look at the denial reasons the payer is giving you on your explanations of benefits (EOBs).
AUDIO EXTRA: How to tailor your appeal to the payer you’re working with.
“My first step is to ascertain and review the status of that claim. I try to gain the ‘what and why’ of the situation and then address the particular issue,” explains Cheryl Nash, director of operations and senior account rep at American Physician Financial Solutions in Colorado Springs.
Payment delays: Check online to see if you can find any relevant information about current problems with particular payers.
Example: Cigna has been delaying payment for all State of Illinois patients, says Gaye Pratt, coder/biller for Vincent P. Miraglia, MD, in Stuart, Fla. “I have claims from December that still haven’t been paid,” Pratt laments. “Cigna has posted a letter on their Web site, dated 2/23/09, stating the delay is because the State of Illinois can’t pay their bills. And although that letter was dated 2/23/09, when I called Cigna [recently], they stated the claims were still on hold since they still had not received money from the State of Illinois to date.”
Improper denials: You first need to determine if...
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