Claim Stalls Over Patient Questions from Insurance
Patient paperwork delays can stall your reimbursements. Learn why insurers request info, how to catch pending claims early, and the proactive steps your team must take to ensure you get paid.
Transcript:
Marc:
We hope you’re having a great week. This week, we are joined by Brandy Brimhall, who is the COO of Practisync, and just as a reminder for many of you, Practisync is a wholly owned subsidiary of the Illinois Chiropractic Society and provides a number of services, but primarily billing services for doctors who want to outsource their billing and hire experts that are incredibly good at what they do. But we’re going to cover a few things billing-related over the next several weeks. And the first one is this. It’s really interesting, because we get these calls occasionally from our doctors, but I got a letter from Blue Cross, Blue Shield for myself, requesting additional information. They want to prove that it’s not a they want to prove it’s not a PI case or an injury related to a different accident where they’re not responsible. So they’re asking me to call and give them information. Otherwise, my chiropractic physician, my doctor, isn’t going to get paid for the services that he provided. What do you see in this regard, Brandy, when you’re handling the billing?
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Brandy:
Well, I would say that it’s something that’s very common. Any payer can request additional information from a patient at any time. There are some payers that are more commonly known for doing that than others. So the first thing is to read your EOBs and read the glossary on the bottom or the reverse side of them, because it will tell you if the charges aren’t being paid at this time, because information has been requested from the patient but not yet received, and that’s specifically what that reason code says. So in that event, when those come across your desk in your office, a good next step wouldn’t be to just assume that the patient has gotten their mail, opened their mail and proactively executed. I think a good and best practice would be to put an alert and a note in your software that this is the reason this claim is pended. Contact your patient and let them know that their claim is currently being held for reimbursement or coverage until they contact their payer and resolve whatever questions that the payer has, so they need to do that, or their claim isn’t going to be processed for coverage and reimbursements.
Marc:
Yeah, because what can happen. And I understand the system, I understand the penalties if I don’t send in the paperwork. But patients don’t always get it, right? They don’t. There’s not necessarily an alignment. They may get it and think, Well, that is ridiculous. Of course, it’s not related to a car accident. You should know that? Well, even if they should know it, they’re going to find a way to delay this claim processing. And so I think, Brandy, you bring up a really good point. Offices, you need to make sure that you’re proactive. Is it a hassle? 100% I absolutely agree with you. But at the same time, you want to get paid. You’ve provided a good and valuable service. You deserve to be paid for it. You’re going to have to have somebody on your team, go ahead and pick up the phone, call the patient, make sure that they have to send in that information, and they have to address that with Blue Cross, Blue Shield, or with United Healthcare, or with Aetna, or whoever their carrier is.
Brandy:
Yep, absolutely, we have to assume either the patients maybe will say they didn’t get it. Maybe they don’t open their mail and didn’t read it. Maybe they looked at it and thought, Oh, the clinic will handle this. There’s nothing I need to do. So assume they’re not going to be proactive, unless you prompt them to, and you’re you want to get paid, take that proactive approach on the clinic side.
Marc:
Yeah. So be proactive. Give the patient a call. That’s super important, and the more information you can provide them, if you have the phone number, if that’s included, whatever you’ve got, whatever information you have, give it to the patient, make it as easy as possible on them to go ahead and make that call. We hope this information helps you out, and we’ll catch you next week.
