This document provides tips and guidelines for medical billing claim follow-up and accounts receivable collection. It recommends maintaining accurate contracts and fee schedules, establishing claim follow-up protocols, setting collection goals, tracking denials and payment trends, being persistent with payers, and promptly following up with secondary payers after receiving payment from primary payers. The overall focus is on active claim management, regular follow-up, and using available resources to maximize collection.

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3. • Recommend loading and maintaining contracts in
software – include:
- Rates by CPT
- Discount on multiple procedures
- Implant allowance
• Maintain up-to-date copy of contracts
• Provide personnel with current insurance matrix
• Maintain implant fee matrix
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4. • Some direct-entry electronic claims
are now being paid in less than a
week
• Electronically submitted claims –
follow-up in 1 to 2 weeks after payer
acceptance
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5. • Establish claim follow-up dates by payer – times will
vary by contract and industry standards
Example: Medicare versus WC claims
• Utilize a good tickler system so follow-ups are not
missed
• Develop company-specific protocol for handling
delinquent payers
• Respond immediately to payer requests, i.e., operative
notes, invoices, etc.
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6. • Collectors need to:
- check aging by payer report weekly
- work A/R by payer, age and $$ amount
- use websites for payment information
- be alert to common payer responses
“Claim not on file”
“Claim processing”
“Check is in the mail”
- understand contract allowances
- enforce contract language
- enforce state prompt payment legislation
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7. • Set collection goals based on:
- current budget for monthly collections
- plus additional percentage for old
accounts receivable
• Provide collectors with a spreadsheet
allowing them to see an ongoing
comparison of daily goals versus actual
collections
• Post charts showing quarterly progress
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100,000.00
200,000.00
300,000.00
400,000.00
500,000.00
600,000.00
Goal Jun-18 Aged A/R = + 5% Total Goal Jun-18

9. • Collectors need to:
- document claim status
- request interest where applicable
- understand payer’s appeal process
- use appeal letters – include information
needed to support claim
- follow up on appeals promptly
- take appeals to highest level available
- verify proper address for appeals
- call accounts by payer – discuss all
outstanding claims with one call
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10. • Follow claim denials using a denial log –
some suggested categories include:
- registration errors
- form errors
- clearinghouse errors
- payer error
- no pre-authorization
- coding error
- needs additional information
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11. • Be alert to payer trends:
- Slower processing
- Requesting extra discount
- Rental network game
• What to do if they just won’t pay
- Appeal to the top level
- Use contract to get paid
- Contact state insurance commissioner
- Don’t give up
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12. • Be firm and persistent
• Build relationship with payer reps
• Don’t depend on websites for all information,
phone call when necessary
• Get definitive date of payment
• Request reference call number
• Document dates, names, promises, etc.
• Enforce state prompt payment regulations
• Immediately send any requested information
• Follow-up again within a few days
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13. CHASING THE BALANCE
• After correct payment received from primary
payer, transfer balance to secondary payer
• Determine whether primary automatically
forwarded claim to secondary payer
• If not, send copy of original claim and EOB
to secondary payer immediately
• Use same guidelines as for primary claim
follow up
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14. © Serbin Medical Billing, LLC 2018 14