Unfortunately, this is a common theme seen in ASC billing offices, and balances often end up written off when the prospect of payment seems unlikely. When this practice continues to snowball as the problems go unsolved, centers will likely see an increasing loss of revenue as they are unable to collect.
That’s where we come in. After having faced this problem ourselves, we’ve found the best practices for avoiding consistent denials and obtaining payment from those stubborn payers.
First, dig through the layers.
When faced with consistent payer issues, start by finding where the problem lies within each claim. Think of this step as peeling an onion - to get to the second layer, you must first peel back the top layer. So, we start with the first layer - was there an issue on the initial claim submitted? Once you’ve checked that layer, peel it back and move on to layer two. When reviewing the remit, was there a denial? If so, notate this and look into the code being denied. Track the denied code for each claim, as this will be beneficial in the next steps. If layer two was clear, move on to layer three and check on the payment; did the payer simply not pay, or did they not pay the expected amount? If the latter, do your best to determine why the payment was incorrect, be it from the insurer grouping, or an incorrect fee schedule.
Next, identify patterns.
If you are faced with a payer that is consistently causing problems, chances are there is a pattern to discover. If your issue is consistent denials, take a look at the denied codes and see if you’re having the same code(s) denied time and time again.
Are your claims being approved, but payment is your problem? You’ll want to discover the pattern here, too, from the insurer having low payment rates, paying on incorrect codes, or not paying at all.
Discover the roots.
Now that you’ve determined your patterns, it is time to dig deeper and get to the root of the problem. First and foremost, you want to follow the insurer’s protocol as it may apply to appeals and other processes in order to maintain a positive relationship. If your appeal is denied, it is time to chat with the insurer. Before reaching out to discuss any issues, make sure you are prepared with examples of the issues at hand, and sufficient documentation for all claims in question.
When delving into lackluster payments, follow any protocol that may be in place before reaching out to the insurer directly. Discovering the cause of improper payments will give you a catalyst to build on in order to ensure prompt and proper payments moving forward.
Once you’ve discovered the problem, implement your solution; from adjusting coding to including additional documentation, task yourself with double checking your claim before submitting to ensure you are doing your best to avoid any hold-ups along the way.
While finding the root of the problem may take a bit of detective work, it will pay off in the long run as you see your problematic payer paying promptly, and staying out of your higher aging buckets.
Whether your payer problems are new or months in the making, in2itive is here to help. With our A/R Clean-up service, we will dig deeper into your A/R issues to find solutions, obtain payments, and set your center back up for billing success. To learn more about how A/R clean-up could benefit you, give us a call at +1 (855) 208-5566 or email info@in2itive.org.