Insurance Review Procedure

This post sponsored by
Common Ground Chiropractic Center.
2927 NE Everett Street, Portland, OR 97232.
503-232-4099 commongroundpdx.com

Accounts Receivable Aging

An aging report is a list of customers' accounts receivable amounts by age. The report is usually divided into columns of 30-day increments such as 0-30, 31-60, 61-90, 91-120, and 120+. It alerts management to any slow paying accounts. AR the main tool a collector uses to identify what accounts need attention and action.

Here is a sample AR report from a printer. (instead of patients, they have suppliers) It shows the key data: who owes money, how much, and when is it due. Some are simpler, some are more complex. If your computer system doesn't produce Aging Reports for you, first call your billing software tech support. AR is such a basic tool that every account management software system should have a useful one.

One warning about AR, though...

If charges, billing, payment and write-off posting are backlogged,
your Accounts Receivable and Aging will be false.
Handle your posting first.

If your patient and account filing is backlogged,
your charts and EOB's will be unlocatable.
Handle your filing first.

Now you can print and handle your AR report.

There are four main types of insurance: Group, Auto Injury, Workers' Comp, and Government. You don't have to do all of them at once every month. For example, in one office, each Tuesday I look at the AR for one type of insurance account, and rotate through the four types each month. In large or specialty practices, one type might represent most of your accounts, and take weeks to go through at first. Some types take only a few minutes to review, so double them up. Adjust your schedule and staffing to accommodate the needs of your practice.

On the day you regularly schedule to address your overdue accounts, catch up on your posting and filing, then print out the "AR by insurance type" for the types you need to review today. Printing this on reused paper is fine, since no one is going to look at it but us.

In Oregon, Insurance companies have 60 days to pay or deny a claim. Add in a little time to write up the charts, post the charges, send the claim, and get the reply, it is realistically about 75 to 90 days (11 to 13 weeks, three months) before you can even consider insurance money "overdue." The more recent stuff, you can work on it, but there's going to be a lot of "yes, we have it... we're still processing it" results that will waste your time. Adjust your schedule if your state rules are different: some states allow only a 30 days processing time. But in Oregon,

Any insurance 90+ days owing needs action.

Quick, highlight every account with 90+ days owing claims on it. Those are the ones to address.

Claim Review

Review is a short action, taking no more than 6 minutes with an account.

1) Scan the overdue account to locate the exact charges that are overdue

• a) Look at the individual account ledger.
• b) Unpaid charges are marked different ways in different software... learn yours.
• c) Find the oldest unpaid amounts and come forward in your work.
• d) Those old unpaid charges should about equal the amount overdue.

2) Each overdue charge gets a separate handling: Open the account file to see the EOBs.

• a) if it's not billed, or if you have no EOB, bill it again, or
• b) if nothing is paid at all, call to verify insurance.
  
• c) if you already re-billed, and it's overdue, no reply again, call to verify insurance.
• d) if have an EOB in reply, read the EOB, and decide what to do

3) Decide what to do and do it. The action is usually one of these:

• a) write off what you must and bill the patient what's fair now.
• b) send a corrected claim with additional data, notes, or authorizations
• c) contact the insurance to clarify their reply, then act.
• d) flag the account for a more complex handling. (this is really rather rare)

4) Write what you did so you won't needlessly repeat what you did next month.

• a) keep your notes in the patient account file.. they will help you later
• b) find where you can keep account notes in the computer billing system... and use it.
• c) Mark off your AR list that you handled this account.
• d) Use a tickler file entry for any follow up you need to do soon.
  
• e) Put away the patient file.
  

As soon as you are done with one claim review, go to the next claim on the aging list and handle it until you get to the end, and the project is done til next month. Sometimes, though, the account is too complex to sort out with a short review. Those need an Account Audit... in another article here.

If your aging list is very long and needs lots of attention - more than you can give it today or this week - target the largest accounts first and handle them. Then go for smaller accounts next time. Or target by insurance company names in order (A-M this time, N-Z next time), or by patient names. Whatever works for you.

In a few months, this job will become smaller, since you will have most claims running smoothly, with notes in the paper files, computer files and tickler file. But you will always need to do this one last step:

Schedule when to go back to this job next month.

All the best to you and yours, Gary

This post sponsored by
Common Ground Chiropractic Center.
2927 NE Everett Street, Portland, OR 97232.
503-232-4099 commongroundpdx.com