About LASHUNDA Expertise Billing,Claims, and resolutions to the following insurance agencies: Medicare, Medicaid, Coordination of Benefits, Most Managed Care such as HMO's, PPO's, Medicare Advantage Plans, Governmental Agencies such as Work Comp and Veteran's Administration. I would like questions that are in regards to Billing and Collections from Insurance Companies. I can also accept some questions regarding accounts sent to Medical Collections. Please be advised that I reside in Texas and most of my knowledge is based on how it works in Texas.
Experience I have worked in the Medical field for 15 years. I currently help to coordinate contracts for a physician group in Texas. I am extremely good with resolving issues with commerical insurance companies. I'm an expert in coordination of benefits between Medicare and Commercial insurance companies.
Question QUESTION: I do medical billing for an office that see patient of all ages and all insurance. we are trying to get everything electroically to eliminate paper. I am fining it really hard to keep up with with following up on claims.from what i did in my classes at school, if the informaition on the claim is correct there should not be any reason for unpaid claim.And is there an amount of time for me to contact insurance to chk on claims? becuase there are times where i send the information they are asking for and when i call to follow up the never receive it. do you have any tips to make following up on clams more easier?
ANSWER: Hi Bibi. Thanks for the question. Usually an insurance company should pay claims within 45 days (if paper) or 30 days (if electronic) however each state has a different set of regulations of when a claim should be paid. It also depend upon if the claim if for a fully insured plan in your state or an erisa claim (self insured plan). However, with either case you should at least expect a payment or response within 45 days of filing a clean claim. There is no easy way to follow up but I can suggest you use the tickler file system. This is a date system that you is usable to track claims filed and to follow up with in 30 to 45 days after the claim is filed. An example is if you send a claim on June 1st (using an alphabetizer or a numeric system) then file the claim on June 30th to follow up. If you send a claim on June 2nd file the claim in your system to follow up on July 1st. So on and so forth. If you have not received a response by the time the claim comes due to follow up (such as June 30th in this example) then send the claim again along with a demanding letter for payment. Follow that claim up in 10 days. You should always know which state laws and which agencies you can report slow payment to. You should also know the language in the contracts that spell out how a ins co should pay claims. All this is important when doing billing. I wish I could go into more detail however this is just email and a question and answer website. I don't think it's meant to be instructional.
Good luck and I hope this helps!
LaShunda
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QUESTION: The thing is i find my self not being able to follow up, i tried doing this way.The office i bill for is a walk in clinic so the doctor see about 30-40 patients a day usually I've heard that regular office would see maybe 10-15 patients a day,i feel like i am falling behind and can't catch up no matter what i try.Should the amount of patient an office see effect the follow up?
Answer If all that you do is the billing for that office and not the actual front office work. Then the amount of patients being seen in that office shouldn't hinder you from keeping up with the billing/follow up. But again, I'm not sure of what you do there and only can provide a suggestion of how to coordinate your follow up. You may need to use a different method to follow up including the tickler system. I would also try organizing the bigger insurance plans in a different tickler. Therefore, when you call on them you have several you can inquire on at the same time. You might also try using the internet to follow up. Most of the bigger plans have websites where you inquire about the status of claims, appeal claims, submit claims, and so on and so forth.
