Elizabeth Woodcock on Insurance Follow up: Timeless Advice
Fill in the blank. Most of the revenue coming into my practice or organization is from ________.
Yes, of course. Payers. That’s why insurance follow up is so important. Elizabeth Woodcock, MBA, FACMPE, CPC is an industry favorite speaker, author and trainer specializing in medical practice management. In a webinar she held with us nearly two years ago, titled Revenue Cycle Management: Keys to Success, she shared some golden – and timeless – advice on insurance follow up. Tune in here (fast forward to minute 28:26), or read on for the high points.
Three outcomes can come from submitting a claim. Let’s be clear here. A submitted claim will be paid, denied, or remain open. And guess what? All three require follow up.
Paid claims A paid claim is what we all hope for, but we still need a way to effectively flag any transactions at the line item level that are not paid correctly. How? Make sure your fee schedules are loaded for every payer, and know the reimbursement schedules.
Denied claims There are a million reasons, it seems, that a claim may be denies. These claims must be worked if payment is ever to be made. How you work them, though, is vitally important.
Open claims These are claims that end up in the “trash can in the sky” – the ones that do not generate a response at all. Because there is no magic wand, you need to be a process in place to find them, work them, and resolve them.
It’s great that we’ve moved beyond white out, ledger cards and peg boards. Our practice management systems today have replaced all that, but what’s often still missing today is an algorithm – a protocol – that directs your every step when handling claims.
What to do when you have follow up:
Start with the reason code. Every well-functioning insurance follow up workflow starts at the same place: the reason code. Why? Because it shows us the next step we should take. As an example, when you get a CO18 (Contractual Obligation), don’t send it to billing! Send a PR (Patient Responsibility) to billing, but don’t do manually. Reason codes related to PR ideally should never hit human hands, as your system should be set up to shoot them over to your statement process.
Identify the payer. Like the reason code, your system should identify the payer.
Take action. Don’t but it in the trash. Don’t file it in a color-coded folder and stash it on someone’s desk. Take the immediate action that is necessary and move it off your screen and desk. So, if it’s a denial, post the zero dollar payment, put the claim on hold and….
Move the claim into the worklist of the person in the business office designated to work claims for that specific payer. Your teams should be designed so that it’s obvious who can do each job the best. Teams should have a Medicaid specialist, commercial payer specialists, and every team should have a coder to work coding-related denials.
Establish accountability. Do you have professional highlighters on your team? You know – the ones who print a 2.5” report every morning and haul out 13 highlighters, blue for Blue Cross, green for Medicaid and so on. There’s no time or room for these archaic methodologies. Set parameters and hold your staff accountable: Claims must be touched within 72 hours of being routed. Specialists must touch 50-70 claims every day.
Take these steps, and you’re well on your way to managing denials with efficiency and results…because getting a claim paid is what makes your revenue cycle complete.
See the complete webinar here. Skip to minute 28:26 for the insurance follow up segment. And below, you can downloard the story of insurance "done right" at Northeast Georgia Health System.