Expediting Payment of Insurance Claims

by Jeff Smolen

If you are reading this, you don’t need to be told that the bulk of your revenue is dependent on the major insurance companies, BCBS, HAP, Aetna, etc… Millions of dollars are spent by practices and hospitals on software to “scrub” the claims before they are submitted to insurance companies, but they don’t get you paid. Now tens of millions more are spent on FTEs to follow up and find out why these claims haven’t been paid.

Usually these FTEs are overworked, inexperienced, and turn over frequently. They also tend to be the lowest paid member of any practice. They spend a lot of time on hold, following up on these unresolved claims which are parked in the 90day+ column. Yet these employees fill a need since they try to get money on the 10%-20% of claims which are rejected, lost or “held in review.”

There is, however, another way to effectively handle the follow up on non responsive insurance companies…harness the power of third party impact.

The reason this approach works for hospitals and practices is that Insurance carrier by-laws and internal policies typically require immediate response to licensed third party contacts. In addition, third party demands move the responsibility for the claim from a clerk to a supervisor, who generally settles the claim more quickly. Even if the claim is rejected, the practice can more quickly move the bill to patient responsibility and resolve the balance issue. Bringing in a licensed 3rd party to pursue delinquent claims leads to a quicker resolution of claims, reduced FTE expenses, increased cash flow/profitability and lower office stress.

Jeff Smolen represents GreenFlag Profit Recovery by Transworld Systems. TSI has been providing medical practices, clinics and hospitals with cost effective A/R solutions for over 38 years. TSI has achieved Peer Reviewed status with HFMA, and has been an Adminiserve Partner with MGMA for 10 years. Jeff can be reached at 313-617-7360 or at jeff.smolen@transworldsystems.com.