Unpaid or aged claims can be reduced to a great extent by managing collections process and following up on accounts receivables quickly.

1. Increase Revenue with Better Management
of Unpaid Claims
Unpaid or aged claims can be reduced to a great extent by managing collections process
and following up on accounts receivables quickly.
OUTSOURCE STRATEGIES INTERNATIONAL
8596 E. 101st Street, Suite H
Tulsa, OK 74133
Phone: 1-800-670-2809

2. www.outsourcestrategies.com 1-800-670-2809
Failing to manage unpaid or aged medical claims can lead to loss of revenue for any
medical practice. To improve the efficiency of collection operations and to increase the
revenue, an efficient tracking and follow-up system is crucial. Unpaid or denied claims occur
mainly due to reasons such as –- the failure to meet a deadline for submission, insufficient
documentation, incorrect modifiers, termination of coverage, lack of pre-authorization or
invalid medical codes.
Resubmission of medical claims often adds to the expense of the process. Medical coding
and billing companies can help practices reduce the amount of unpaid claims.
Professional companies follow a systematic step-by-step process and provide reliable
collections management services that will help in receiving your payments without delay.
Crucial Steps to Manage Office Claims
 Consider basic medical billing steps – Basic steps include verifying the patient’s
identification and health insurance benefits, collecting copayment and co-insurance
and generating a patient encounter form.
 Ensure proper coding – Entry of accurate CPT, HCPCS and ICD-10 codes is crucial.
Always check for the latest codes used. To avoid claim denials and resubmissions, it
is also necessary to make sure that all these codes are supported by clinical
documentation in the patient’s medical record that shows medical necessity.
Supporting documentation includes copies of medical reports, authorizations, lab
reports and other relevant records.
Claims Lifecycle
 Submit claims faster – Though most insurance companies allow 60 to 90 days
from the time of service to file a claim, submit your claims as early as possible. Filing
claims too long after the date of service may result in claim rejection. Provider’s
signature is required for manual processing. For electronic claims, the physician’s
EDI number and password will serve as signature.
 Adjudication – Insurance payers make medical claim adjudication decisions based
on the claims submitted. The provider will be notified of the details of the
adjudication in the form of an explanation of benefits or remittance advice. Medical
billing specialists should verify that payer rules and regulations have been followed
and that the claim covers the services provided and documented.

3. www.outsourcestrategies.com 1-800-670-2809
 Track claims and appeal denials – Tracking claims attentively can help to avoid
aged claims. Billing professionals should maintain a copy (electronic or paper) of
each submitted claim, and review the remittance advice to make sure that the claim
was paid accurately. For non-payment issues, draft an appeal and resubmit the
claim.
 Focus on collections – It is now more important to closely manage the patient
collections process. Consider the latest claims first. Some patients request to bill
coinsurance and copayments. While considering older claims, determine the
coverage, review records to check whether the claim was paid, denied, or is pending.
To collect missed patient co-pay and deductibles, professionals can choose to -
o Call the patient within one week after the encounter
o Mail a copy of the invoice 10 days after the due date
o Mail a reminder two weeks after the invoice
o Make at least one collection call to determine the reason for delinquency
o Mail a collection letter if required
Submitting accurate medical claims and getting the medical billing process right the first
time will reduce the amount of aged claims in your medical practice.