The end of the year is approaching rapidly and one thing you do not want to do is drag old A/R into the New Year. If you have any A/R from 2013 or (gasp!) 2012, it's time to look at those claims and make a decision if you are going to continue to chase them, or make necessary adjustments and move on.
I often am asked, "At what dollar amount do you cut off chasing claims?" It's very insurance-plan dependent. However, if you have outstanding A/R from 2012 or 2013 and those claims have been followed up on repeatedly, you need to look at this from an administrative cost standpoint. If you have already spent money paying an employee to follow up on claims, then it might be time to make the adjustments.
An entire A/R review should be done quarterly so that you are aware of how efficiently your claims are being followed up on, and where consistent denials are happening. If your claims are not being followed up on as often as you'd like, this is a conversation to have with your billing department, to find out why:
• If the claims are being followed up on, yet are still being denied, perhaps some more claims follow-up training needs to be introduced.
• If you find a specific payer denying claims consistently, it's a good idea to take a look at the reason codes.
• If claims are going out without a referring physician, or correct policy number, you have a problem in the claims scrubbing department. That should be addressed immediately.
If you find you have to make several adjustments because of controllable errors, then it is time to have a conversation with your front- and back-office staff and introduce new policies and procedures. Here are trouble spots to look out for:
• A clinic error which includes exceeding insurance limits - this should be obtained when verifying insurance;
• No authorization for a specific date of service - often one or more dates fall outside of an authorization from an insurance company;
• Codes not authorized by an insurance company - if it's not on the authorization, don't code it;
• Insurance has expired prior to the patient coming in - if insurance verification was done ahead of time, this would rarely happen;
• Copays, coinsurance, and deductibles not collected at time of service;
• Chart notes not available for a specific DOS; or
• Seeing a patient with insurance you do not accept.
You need to identify why A/R is being generated so that you can create a process that stops the above-mentioned behaviors from happening. You cannot control all insurance denials. However, the errors that happen internally can be managed a lot better than they are now.
Do your A/R review before the end of the year and see what you find. Start the New Year with a great process and unload that uncollectable A/R today.