Medical Office Billing: 7 Ways to Escape Computer Claim Casualties

Posted on 22. Oct, 2009 by Editor in Hot Coding Topics

Pay attention to EOBs and keep talking to your MAC.

You could be losing money to a computer glitch and not know it, experts say.

If you don’t nip a computer glitch in the bud, you may be plagued with improper denials and other claim holdups. Here are seven things you can do to seek out and solve glitch-related problems:

1. Eyeball Your EOBs

Watch your explanation of benefits (EOB) forms, and keep your eyes open for denials and downcodes that don’t look correct.

2. Check Your A/R

Always review your accounts receivable (A/R) to ensure that you’ve received the payments you’re due. If a computer glitch kept your MAC from paying you, don’t hesitate to point it out to the payer.

“If we have any claims outstanding for 30 days that we sent electronically to that carrier, we contact the carrier right away,” says Ginny McManus, billing manager with Berger Henry ENT Specialty Group in Pennsylvania.

“If we are told there is no record of receiving the claim(s), we will rebill immediately,” McManus says. “It is definitely up to the practice to catch these problems. I have run into this scenario before and the carrier has never automatically reprocessed any of our claims. Good follow-up is everything in a billing department.”

3. Don’t Blindly Believe MACs

If you contact the MAC and the representative tells you that the payer plans to reprocess all claims affected by the glitch, always recheck that they’ve followed through.

“Once I’ve submitted the claim, I will have our collector call back in two days to see if the claim has been received by the payer,” says Kathy Philp, CPC, director of billing with Praxis Health Group in Oklahoma City. “I have the collector explain to the representative that they have by law to...

Tags: A/R, accounts receivable, carrier, CMS, computer, EOB, explanation of benefits, MAC