Why claims aren’t getting paid at your medical practice

Posted by: Admin User

Posted on: Fri Jun 14, 2019

Skyline Medical Billing Management can help your Prescott practice stay in the black with expert claims submission and follow-up.With all the busyness that occurs in physician’s offices, it’s common that the staff members in charge of claims billing are “borrowed” to perform other duties as needed. This could render your Prescott practice unable to do proper follow-up to ensure claims are being paid. Skyline Medical Billing Management understands how important follow-up is to the claims process and offers reasons why claims may not be getting paid at your practice.

Here are three explanations for claims going unpaid:

1. The claim was not received by the insurance company

Paper claims are sometimes mysteriously lost in the mail. For this reason, send claims electronically whenever possible. Without timely follow-up, a month or longer could pass before your staff is aware that the claim hasn’t been received. When submitting paper claims, allow about 10 business days before calling the insurance company to verify the claim has been received. For claims submitted electronically, you should be able to verify within five business days. Timely follow-up ensures receipt and more prompt processing of your claim.

2. The claim was denied

With proper follow-up, you can submit a new claim before you receive the hard copy of the denial by mail. Following up by phone with the insurance company and learning the reason for the denial gives you the opportunity correct the cause of the denial. The sooner you are able to resubmit a claim, the sooner you can get paid.

3. The claim requires information from the patient

If additional information has been requested by the insurance company, the claim could be placed in a pending file awaiting the response from the patient. Rather than waiting for your patient to receive a letter and respond, a phone call to the patient can be helpful in getting the information supplied to the insurance company promptly, and getting your claim paid. You might consider making a conference call with the patient and insurer to expedite matters.

At Skyline Medical Billing Management, we understand how busy your office can be, and we want to help you keep your claims processing going smoothly. If your Prescott practice is experiencing delays or non-payment of claims, let the professionals at Skyline Medical Billing Management handle your claims. Our dedicated team will deliver maximum accuracy and follow-up to keep your practice in the black. For more information on how we can help you, contact us at 928-227-1167.

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