Billing is one of the most complicated and frustrating components of healthcare practice management — primarily because it involves navigating a complex insurance landscape. It can seem inevitable insurers will bounce back a rejected claim with little to no insight as to why. This, in turn, prompts a provider follow-up for more information, which can feel like pulling teeth.
It doesn’t need to be this way. Instead of viewing insurance follow-ups as cumbersome, frustrating tasks, consider a few tips for making them as fruitful as possible. By staying on top of insurance claims and working closely with payors to understand the requirements, you can streamline the billing process to minimize denials and delays.
Follow-through is important
Insurance follow-up is a crucial part of the claims process that providers must take seriously. After all, it ensures they receive timely and accurate reimbursement. Following up on insurance claims also allows providers to identify and address any issues preventing revenue from making it into the books, such as denied or delayed claims, incorrect billing, and other discrepancies. But what exactly does follow-through mean?
To effectively follow up on insurance claims, providers must understand the claims process. This includes knowledge of deductibles, copayments, out-of-pocket expenses, and other factors affecting reimbursement. Providers must also be familiar with the various insurance plans and policies accepted by their practice, as well as the different rules and regulations governing claim submission. Needless to say, there’s a lot to keep track of.
How to prepare for a follow-up
To ensure a successful follow-up, providers should start by gathering all information related to the claim, including:
- Patient and insurance information
- Transcript of services rendered
- Billing codes and classifications
- Any other relevant data as specified in a claim rejection
Along with this information, you should have a clear understanding of the reason behind the denial and gather any additional documentation or information required for resubmission. It’s also a good opportunity to recheck the documentation of services provided before following up on the claim. You can remediate errors prior to discussing the claim, which may even negate the need for a follow-up.
Once you have the necessary information to discuss the claim, contact the insurance provider. Then, it’s a matter of discussing the nature of the claim and bridging the gap between what’s missing for successful reimbursement.
Open a line of communication
Opening a line of communication is essential for healthcare providers when dealing with insurance denials and rejections. It allows providers to take basic steps to increase the likelihood of successful reimbursement.
Providers should establish a point of contact with the insurance company and keep detailed records of all communication. It’s also important to be concise when discussing the reason for the denial or rejection and to present documentation and information clearly. Remain professional and respectful when communicating with insurance representatives — even if you’re frustrated or disagree with the denial. By approaching an insurance follow-up as a relationship-building experience, providers can increase the likelihood of a successful appeal and maintain a positive relationship with the insurance company.
Stay on top of denied claims
Insurance follow-up is a crucial part of the revenue cycle management process for healthcare providers. Not only does it supply the information you need to reprocess denied claims, but it can also create rapport between your practice and the insurance company, leading to a smoother, more informed claims submission process in the future. Asking the right questions and providing the right information are quick ways to put your practice on track to a faster, more fruitful RCM process.
To ensure successful insurance follow-ups in your RCM process, contact the experts at trubridge.com.
