When it comes to filing claims, the clock starts ticking on the date of service, and everyone wants to move their claims smoothly through the revenue cycle on the first try. Unfortunately, that doesn’t always happen. And for any claim that requires extra attention, be diligent in your follow-up.
It’s often difficult to get payers to respond to your requests on more challenging, time-crunched claims. Emails and phone calls may go unanswered, unless of course it’s to inform you that the claim was conveniently received after the filing time limit.
If you’re dealing with a denial or rejection, analyze it carefully for the following:
- Check payer specific guidelines on reconsiderations and appeals, and know the timely filing limit for both. Most payers require you to submit a payment dispute or reconsideration before you can appeal your claim.
- If they have a form, use it. Bureaucracy loves the system, and filling out the form properly the first time will improve the odds of your claim being expedited for payment.
- When you call about a claim and are told it is not on file at the payer site, verify the patient is their insured client, that it was filed to the correct mailing address or with the correct electronic payer identification, and that your facility is on file with correct W9 information. If all your information was correct, ask if a fax number is available to resubmit your claim.
Now, for the times when you have to make a second call (it should never take more than that) and are still feeling ignored, call and ask for a supervisor. If the receptionist answers, tell her no one ever calls you back—definitely don’t hang up if you’re left with the same answer as before. If you have to leave a message, put it in the general mailbox and let them know you’re getting the runaround; it’s best not to use a particular person’s voicemail because they will be the only one to hear it.
Here are some effective options for that second follow-up call:
- On the company website, look up the president or CEO and send them an email or fax about how delightfully inefficient and difficult their employees are being.
- Send a letter over the general fax line explaining how many times you’ve called and left messages. Don’t be afraid to name the person you’ve tried to contact. Response time is almost instant when you do this.
- Lastly, in today’s connected world, social media is your friend. Find the company on Facebook and LinkedIn, where they usually list a phone number that is not on the website. Be sure to let them know exactly why you’ve had to go through such measures to reach them.
But the most important thing to remember when dealing with payers is that your claims are important to the facility’s financial success. So if their inefficiency is impeding your payments, being a squeaky wheel isn’t the worst thing in the world.