Reimbursements depend on the number of clean claims submitted to insurances, hence the count of claims that go out of the system everyday becomes an important number to track. Many centers tend to overlook this number and so there is no way for them to be certain if all claims go out of the system. This is a more serious problem than it seems, because physicians spend time, energy and resources seeing patients and missed claims eventually result in loss of income, a bloated AR and dissatisfied doctors.
Here are three steps to ensure effective claim tracking:
Missing Claims Log
At the end of each claims submission cycle, the billing staff must run a report from your practice management system of all the claims submitted to insurances. Cross verify the number with the total patients seen for that particular cycle. Both numbers must match. For example, if your billing report indicates that 170 claims were submitted for a certain date of service, then 170 should be the number of patients seen on that date. Any discrepancy with the number will mean that there are claims that have been missed.
Open Claims Log
There might be instances when a physician may forget to digitally approve a particular visit or she may have saved the claim as a draft in an EHR and forget to submit. If using paper charts, your billing teams receive a batch of claims with missing information on a particular chart and decide to keep it on hold. It is important to keep a track of such claims. Deploy a detailed open claims log and have your billing staff document the occurrences of such claims. While reviewing the open claims take the necessary action to reconcile the claims. This ensures no claim is pending in the system.
Along with running reports for missing and open claims every week, run a ‘no show’ report for patients who missed their appointment during a week. Use these numbers to verify that no claims were missed and analyze trends over a period of time to reduce discrepancies between patients seen and claims submitted.
The alternative is to use good software that automates the above for you.