Getting Paid from Secondary Insurance at Your Medical Practice

Are you aware of how much of your aging accounts receivable balances from secondary insurances that were never followed up on? It's time you investigate.

More often than not, patients arrive at your office with a primary and a secondary insurance that they would like you to bill. Out of courtesy to the patient, you accept the cards, enter the information and send it all off to your billing department. But, how many of these secondary insurances are actually being billed, and how many are sitting there in your accounts receivable (A/R) aging out and reaching timely filing deadlines?

There are several secondaries to Medicare that have automatic crossover like Blue Cross and Blue Shield, so a majority of those when billed electronically typically are not ones to worry about. But there are thousands of insurance plans that patients use ranging from the big names, like Cigna and Aetna, to smaller private insurances and employer-funded plans that the automatic crossover does not apply to. Sure, it's only $12 per claim to $25 per claim, but step back and look at how many of these you have aging out. If you have 1,000 accounts with secondary claims pending, this can add up very quickly to inflow that is yours for the taking, and hard earned at that!

Take these steps to investigate and remedy this situation as soon as possible:

• Do you have direct access to your patient accounts and system reports that show balances and your aging out A/R? This is your first step in realizing what is actually sitting out there in your 90+ days. It is critical to identify these specific accounts.

• Once identified, it's time to meet with your billing coordinator. This is a very important next step. It will define the lines of accountability by addressing the specific reasons why these accounts are being allowed to age out. If your billing coordinator feels that “it's not worth their time to bill out such a small amount,” it's time to find a new billing company. It is not their money, it's yours.

• Now that you have identified and addressed these aging out accounts, you will need to follow up within 30 days. You can do this by running specific aging reports, or going into each account and checking when/if those claims were indeed sent out. Most software programs used by reputable billing organizations have sophisticated enough reports that you should be able to obtain this information quickly and easily.

Taking this step right now is very important with your 90+ accounts receivable. Many insurance companies are tightening their "timely filing deadlines" such as some Cigna plans, which are now 90 days from the date of service. You would not have any recourse on claims passing this deadline if you continue to allow those aging claims to sit.

It's always a good idea to review your A/R on a monthly basis to insure you are being paid on claims, are being paid your contracted rate, and know why you are receiving denials. All of these areas are so easy to monitor and are critical to your overall practice's health.

Find out more about P.J. Cloud-Moulds and our other Practice Notes bloggers.