When your reimbursement staff is working old accounts receivable while also trying to stay up-to-date with current billing and collection activity, they can quickly feel overwhelmed. While the high dollar claims always need to remain a priority, you also need to keep a watchful eye on aging claims to ensure that NOTHING is resolved past the timely filing. To avoid this and help your team members focus their efforts, I have a few suggestions (besides of course ensuring your high dollar claims are current) such as prioritize your old claims by the number of days they are outstanding and work in priority order according to filing limit deadlines. Here are some additional tips to help your team ensure maximum collections on their home infusion claims.
Categorize claims by aging buckets:
Categorize claims that are more than 60, 90, 120, and 180 days old. For claims that are more than 120 or 180 days old, you can quickly determine whether the claims are collectible, uncollectible, or questionable. This will allow you to focus on the ones that you still have a chance to collect first. The older the A/R, especially in the 180-day+ range, the less likely it is that you will be reimbursed. When you reach your final determination that some claims are uncollectible, write them off and remove them from your A/R so that you have a clear picture of what has the true potential to be collected, versus what will be considered bad debt.
Know payer contracts and timely filing guidelines:
Payer requirements for claim submissions vary, so your billing staff has to review the terms of each contract to ensure accurate billing according to each payer’s guidelines. Not all payers were created equal. Each payer has its own timely filing deadlines that should be stored systemically so that you will always be able to monitor claims approaching the filing deadline and ensure they are worked as a priority.
Explore creative ways to reduce outstanding claims, especially those over 180 days:
Historical data indicates that many claims over 180 days fall into the self-pay category — when the outstanding balances are owed by patients. With the rates for home infusion constantly being slashed, collecting on co-pay balances are an essential part of the process. You need to be creative versus just sending a monthly statement month-after month. Some suggestions: