Effectively Preventing Unresolved Charges

Working unresolved charges can be very unnerving and, of course, time consuming and labor intensive. Many medical offices are having to deal with numerous unpaid and denied charges because of a variety of reasons such as: cannot identify patient, procedure and diagnosis codes don’t match, patient not eligible on date of service, no authorization for charges and no referral on file. Sound familiar?

Many of these denials can be minimized or avoided only when medical practices institute and follow specific office policies. Let’s examine the policy most practices follow when a patient makes and appointment. The policy should include asking the patient’s name, date of birth, current medical insurance company and amount of co-pay? When the patient arrives for her appointment, front desk personnel should scan member’s card and call for eligibility. Adhering to this policy should help reduce additional administrative time needed to conduct insurance follow-up.

In cases of surgeries, or other procedures which require special medical treatments, it is absolutely essential front desk personal obtain patients complete medical histories, authorizations and, in some cases, letters of medical necessity. Medical personnel need also to make sure that when obtaining authorizations to accurately indicate to insurance companies all diagnosis codes in correct descending order of seriousness and procedure codes. It is also advisable to record name and contact information of the person who either approves or denies authorizations. Strong adherence to this policy should also help minimize insurance charge denials.

Finally, the URS staff has one sure method of controlling and minimizing future costly insurance follow-up campaigns. The staff resolves most of its denied charges when posting payments and calling insurance companies to ascertain reasons for denials and nonpayment’s, then submitting all necessary corrective measures to insurance companies. Those few claims which cannot be resolved during this process are set aside for appropriate handling.