Medical billing tips and tricks that will help anybody new to the field find a starting point with insurance companies. I have been asked many times by people who were essentially 'thrown' into the billing position at their office, 'Where do I start?' You need to first decide what has and has not been done.

If you are coming into a brand new practice and there has not ever been any kind of charges submitted at all, that would be your first place to start. If there are no charges being entered to be submitted either to the patient or the insurance for collection, there is no money coming in the door to keep the practice going. You want to start first by getting all the back log of demographics and charges posted ASAP. Once charges are in and submitted you at least have a starting point to go from.

If you have come into an existing practice that has an excessive outstanding A/R (Accounts Receivable) then your priorities will be different. You will need to get a report that shows all outstanding charges and who they are owed from. If you have the ability to get a summary report that will just show you how much is owed per insurance vs. each patient, you will have a better idea on where to start. When you pull a summary report and can see that one insurance company has $50,000 worth of outstanding claims, then another insurance company with $40,000 worth of outstanding claims, you would be better to start working the insurance company with the higher outstanding balances.

As you work through one insurance company you will want to go on to the next insurance company with the next highest outstanding balance. Doing this will at least get you an idea of where your claims are at and why they have not been paid. As you are calling insurances there are some standard questions to start with. The first question to ask is if your outstanding claim(s) are on file. If the insurance company states they do not have your claim on file, you want to first verify you have the correct claim submission address and you want to be sure that you have the correct subscriber ID and group number on file for your patient.

If all of this information is correct then you can just simply resubmit the claim to the insurance company. If they state they are pending the claim for additional information, then you want to see from whom they are requesting the information. Does the information need to come from the patient or does it need to come from your office? If you are told they are pending information from the patient, then you can either call or write the patient to let them know they need to contact their insurance company ASAP.

You can also move the balance to the patient's responsibility because sometimes getting a bill they know their insurance should pay for will help get them to do what needs to be done. If the information being requested needs to come from your office then you will want to verify what exactly they need and if any other identification needs to be with the information (such as a claim number) when you send it in. If they will accept faxes of the information needed, that seems to get things there a bit quicker to get your claim(s) taken care of even faster. You will see that most outstanding claims will fall into the above subjects and if they do not, a lot of the time the representative you are talking to on the phone can help to direct you as to what needs to happen to get the claim resolved. If you don't know what they are talking about or want more details, don't be afraid to ask.

Remember to make detailed notes when calling insurance companies. Make a note of the date called, who you spoke with, and what you were told. There will be more than once you will want to refer back to your note, whether it be to help fight the insurance company at a later date or to show proof to your physician(s) that you are following up on outstanding accounts.
Unfortunately the follow up with insurance companies is a battle that is never fully won. As soon as you get a set of charges called on, there will be another set of charges that it is now time to follow up on. Don't get discouraged easily as it is just a part of what continually needs to be done to keep up on everything.