Over the last several years, the use of a standardized electronic claim form throughout the healthcare industry has become more popular, increasingly required and easier than ever before.
It’s estimated that over 95% of health plans and providers are now electronic claims for the vast majority of patients. Frankly, I’m a bit puzzled why it isn’t 100% — but then I’m reminded of an eccentric chiropractor who attended one of my chiropractic billing seminars a few years back. He registered via phone (instead of like 90% of our attendees who register online) paid in cash (green stuff at the door) and let me know that he doesn’t trust the internet – or computers for that matter – and wasn’t going to be “suckered into this whole technology thing.” He preferred to do business the old fashioned way and was apparently a fan of bartering for eggs, milk and the like. (Note: I presume he arrived via horse & buggy)
For the rest of us who have at least partially embraced technology as a part of our daily lives, we can recognize both its conveniences and we are left to deal with the drawbacks as well. That electronic claims submission, posting and processing can improve the speed of your reimbursement cycle (in general) is no longer questioned. But there’s still a whole lot that can go wrong in the midst of it all that can certainly slow things to a crawl and occasionally make you want to go back to wampum and join our friend in avoiding computers.
Before you abandon ship, here are few items you should consider to increase the efficiency of your claims and speed of the cycle of how fast (and reliably) you are paid:
Head Pre-Claim Problems Off at the Pass
Most problem claims never should have created trouble, so do these things first:
Verify insurance: A world of angst awaits those who don’t verify – and the problems are aimed directly at both you and the patient. Even the most accurate coding cannot help a chiropractor get paid if the patient’s coverage has lapsed or your service is not covered by the payer. That’s it. No whining, no amount of appeals, nothing will change this. Do not expect to pass go, do not anticipate collecting $200 or even $20 from the payer. Checking eligibility prior to every new patient appointment is therefore the essential first step in the claim revenue cycle. Oh and yes, be sure to check eligibility for returning patients who have been absent a while; surprises aren’t really fun when they find out their insurance has changed for the worse.
As a side note, yes I understand verifying insurance eligibility is one of the most tedious and painful processes routinely occurring in your practice. That alone doesn’t mean you shouldn’t do it. Flossing your teeth or checking to see if that mole on your back has increased in size, shape or texture isn’t a ball of laughs either – but you do it because you know it needs to be done. Same deal for insurance verificaitons. Now that doesn’t mean you can’t add efficiency to the process. After all, if I can’t actually see the mole on my back, it’s more efficient to ask my wife to help me than contort my body into 17 painful positions in an attempt to view that little monster.
In the same way, we should be looking for ways to make the insurance verification process more efficient in our office – not drop it altogether. But that’s another topic for another day. We’ve got to move on (and stop talking about moles)!
Complete pre-authorization (if applicable): Even if a patient has the chiropractic benefits on their plan, your well-intentioned claims may be denied if there are pre-authorization requirements in place. And, if you are contracted, then pre-authorization denials means you won’t be paid – ouch!
Ensure accurate data entry: It’s scary to think that a simple staff error could sabotage your chances of getting paid (at least the first time around) but it’s true. Basic data entry mistakes during the registration process, such as errors in insurance member numbers or patient demographic information, can mean claim denial. It’s not a fatal error (you can always submit a corrected claim) but why waste time and money – be careful and do it right the first time!
Utilize claim scrubbing services: Many clearinghouses and practice management system vendors offer claim “scrubbing” capabilities to catch errors before the claim pushed to the payer. A quick bit of scrubbing often will catch some of the above errors and/or coding combinations that really shouldn’t exist. So if and when you have this tool available to you, use it!
Be aware of deadlines: Last but not least, before you hit submit, make sure you are meeting the timely filing deadline. For many payers, you have one year from the date of service to do this so it doesn’t seem like a big mountain to overcome. But occasionally, the messes pile up and you fall behind and timely filing becomes an issue. And in case you’re wondering, NO, I’ve never seen a payer make an exception to their timely filing deadline!
Follow-Up Strategies to Solidify Your Reimbursements
In some ways, the hard work begins AFTER you’ve done the “real” work of taking care of your patients and the “pre-work” steps listed above. Unfortunately, follow-up is often forgotten or pushed to the back burner in many busy practices, resulting in unnecessary A/R, denials and (most simply) not getting paid for the work that you’ve done!
Claims Tracking Tips: In the “old days” practices really did not know if their claim was received until it was paid or rejected. Occasionally, when a claim went missing for a while this meant the billing person would have to call the payer and chase it down. Nowadays, this process can be incredibly simplified through technology. You can easily track submitted claims using the features such as electronic claim status requests that are available with many clearinghouses, software and payer systems. While some health plans and clearinghouses offer an acknowledgement transaction to confirm that a claim has been received, not all do and unfortunately, this feature is not currently required by law. In order to proactively track claims, providers are encouraged to utilize an electronic claim status inquiry to confirm receipt of submitted claims, as well as to determine claim status. But if chiropractors whose software, clearinghouses or payers possess this potential should definitely utilize this feature to help efficiently track the health plan receipt of your claims.
Running A/R Reports: even if you are unable to electronic claims tracking, all is not lost. At a minimum you should routinely run Accounts Receivable reports to see where your money is. While it’s not quite as efficient, you will be able to see which claims remain outstanding and address problems before they sit indefinitely in your A/R
Old School Strategies: when all else fails, there is an appropriate time and place for picking up the phone. Particularly by the time a claim sits either pending or unpaid for a while (before the 60 day mark) you need to encourage action. Though it’s certainly not ideal, finding a human at the health insurance payer to help you is sometimes necessary.
NEXT STEPS
Certainly, this is not an all-inclusive list of everything you need to do in the chiropractic billing cycle, but hopefully these strategies will help you prevent problems. Hopefully, you’ll be able to avoid one of the biggest headaches (and massive inefficiency) which is not getting paid for the good work you do.
Beyond that, if you find yourself chronically having claim problems, perennially having an A/R that is unhealthy and/or don’t know how to get a hold of your booming billing problems, here’s one clear and quick tip: get help.
Each and every day that you aren’t paid massively increases the chances that you will never be paid – so don’t wait.
