Finding the Glitch in Denied Claims
Much like the evil teacher who gives a student an F on a term paper because they forgot to include the date or some other technicality, insurance claims processors seem to look for any excuse to deny a claim, including minor details like one misspelled letter in the insured’s name when everything else is completely accurate. It’s as if they don’t know who that subscriber is due to a single wrong vowel. Sometimes you receive the denial and bill the patient who is completely and rightfully mystified as to why their insurance didn’t pay. Perhaps that patient will contact their carrier and get it sorted out. Perhaps they will contact you but you’ll likely tell them to contact their carrier. Perhaps the patient will just ignore their bill until they find themselves in collections. Regardless of the outcome, one little glitch in the claim can cause many hours of wasted time trying to understand if the denial is legitimate and who is responsible for the balance.
But what about the situations where the carrier doesn’t even send you a denial? They just don’t respond. Now you don’t know the claim’s status so you call the carrier to inquire. After navigating phone menus and listening to hold music, they typically tell you to refile and you’ve accomplished nothing and they’ve bought another 30+ days. Data shows that 30% of claims aren’t paid the first time1, they are either lost, denied or ignored. The cost of inquiring about a claim is estimated at $9.792 and the cost of reworking a claim is $253. That is a lot of time and money spent chasing claims with no guarantee of the outcome.
If this sounds familiar and you’d like some help with follow up on unadjudicated claims from a reputable company at a cost much lower than your internal efforts, please contact MicroMD e-services vendor TSI. TSI has been providing insurance resolution services to practices for over 20 years and they guarantee their results in writing. Because TSI is a licensed collection agency (largest healthcare collection agency in the country), carriers do respond and they respond directly to you with payment or an explanation of denial or a request for additional notes. In fact, it’s in their bylaws that they must respond when contacted by collection agencies or attorneys which means no more run around for you or your staff. TSI has a track record of achieving a 70% response rate from carriers within 90 days at a cost below 1%.
Contact MicroMD’s designated TSI representative Karen Cooper at 732-704-7626 x101 or Karen.Cooper@transworldsystems.com to learn more about insurance resolution services and/or patient collection solutions.
Sources:
- “Adhering to These 3 ASC Billing Best Practices Can Streamline Your Revenue Cycle Management.” MedicalBillersandCoders.com. June 13, 2017. Web. July 25, 2017
- Bayley, MD, Matthew; Calkins, Sarah; Levine, MD, Ed; and Machado-Pereira, Monisha. “Hospital revenue cycle operations: Opportunities created by the ACA.” healthcare.mckinsey.com. 2008
- Taufen, Amber. “How to avoid unclean claims.” MGMA.com. March 28, 2014
