Pain Point Series: Timely Follow Up and Appeals

Pain Point Series: Timely Follow Up and Appeals

We’re excited to continue our Pain Points Series by talking about what we like to call, the elephant in the billing office. (Maybe if we don’t talk about it, it’s not there!?) Let’s face it, running an Ambulatory Surgery Center (ASC) is complex, and there are always a thousand things to do at once. So what do you prioritize? Whatever is right in front of you at the moment (think: physicians, staff, patients) or anything with a harsh deadline (think: scheduling, credentialing, timely filing).

When it comes to the revenue cycle, most of the ASCs we speak to are able to get claims coded and billed in a timely manner. However, when the conversation shifts to following up on unpaid or underpaid claims quickly, and regularly, people get quiet. It’s nothing to be ashamed of. At the beginning of each week, ASC billing offices across the country have the best of intentions. “This week, we’re going to go through our aging and follow up on all of our unpaid claims.” But then patients happen, rush surgeries happen, onboarding a new physician or employee happens, and before you know it, your aging is looking pretty heavy in that 90+ bucket.

The fact is: if you’re not following up on unpaid or underpaid claims, you’re leaving money on the table. And what’s more, you’re not learning the reason(s) why the claims aren’t paying correctly in the first place. This means your billing office will continue to make the same mistakes, and your clean claim percentage will continue to decline.

If you’d like to make timely follow up and appeals more of a priority, we have some tips that can help.

Check and see if your billing system has a collector’s dashboard (or equivalent) and make sure you’re using it to the fullest. Using a collector’s dashboard, the system can notify you if a claim goes, for example, 35 days and is still unpaid. After doing some follow up, you can extend the reminder out for additional follow up as appropriate. If your staff is utilizing this dashboard, it’s great to check in weekly to make sure follow up is being scheduled and conducted appropriately.

Reorganize your day. If your Accounts Receivable (A/R) follow up is always getting pushed to “tomorrow” or “next week”, it may be helpful to start your day with your claims follow up at least a few days a week. This way you can knock out a handful of cases each day before the emails and patients start rolling in.

Know your numbers. Calculate some statistics like Percent of Aging Over 90 Days and Days in Accounts Receivable. Post them for the entire billing office to see and set some goals on where those numbers should be. Calling attention to these stats and discussing them regularly can help make them a priority for you and your staff.

We hope you find these tips helpful, but if you’re still having trouble keeping up with unpaid or underpaid claims, it’s time to address the elephant in the billing office! Let in2itive help with your 90+ claims. We can relieve you of this burden and increase your revenue. And the best part? We only get paid on what we collect! Give us a call today to learn more about our risk-free revenue offering.

Helpful calculations to know:

Clean Claim Percentage = Claims paid in full the first time they are billed / Total claims billed.

Percent of Aging Over 90 Days = Accounts Receivable aged greater than 90 days / Total accounts receivable.

Days in Accounts Receivable = Avg Collections per Day / Total Outstanding A/R

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