Effective claims management is tricky in an optometric practice. Sometimes, even successful billing managers have trouble collecting reimbursements from insurance claims. If you’re noticing that your claims aren’t getting paid, there’s still some hope. Below are five things you can do if your electronic claims aren’t getting paid.
What To Do If Your Electronic Claims Aren’t Getting Paid
Check for Rejections
Many times, your claims aren’t getting paid because your clearinghouse identified a potential error and rejected the claim before it went to the payer. The good thing about a rejected claim is that if you regularly monitor your rejections, you can rework the claim and submit it again through the clearinghouse in an attempt to collect the reimbursement. However, many billers have so much on their plate that they don’t get the chance to work all of the rejections before the timely filing deadline expires.
Ask Patient To Pay
A less favorable solution to a payer not reimbursing a claim is to bill the patient. Unfortunately, sending a patient a bill requesting more money can strain your relationship with the patient and cause a headache trying to collect the payment.
If the payer denied the claim, identify why the claim was denied, work with the payer to understand the reason for the denial. If you think the payer made an error in denying a claim, work with the payer to understand why they denied the claim, and submit an appeal.
Write Claim Off
If your claim was denied and you think asking the patient to pay will damage the relationship with the patient, then you can write off the bad debt.
Change Your Process
Having some rejected or denied claims is normnal. However, if your practice is continually receiving rejected and denied claims, you will need to look at your claims management process and consider making a change to the process, the tools, or the biller’s workload to help reduce errors and increase profits from claim reimbursements.