Ask Caryl: Decreasing Payer Payment Time
Q: Some insurance companies seem to take longer to pay claims than others. What can I do to decrease payment turnaround time?
Caryl Serbin: First, check internally to determine how long it takes your biller to submit claims. Is it within the usual and customary 48 hours after receipt from the coder? Then check with your payment poster to ascertain whether payments are being posted the same day as received. If there are no red flags on your end, gather all of the necessary data about the claims (e.g., dates submitted, follow-up dates, notes from collector, etc.).
Next, review your contract and state's prompt-payment statutes. Does your contract specify a timeframe in which the payer will pay claims? If so, contact your provider representative and advise them that your claims are not being paid within the time guidelines in the contract and/or state prompt-payment law. If a response is not forthcoming or the reply is non-specific, escalate up the ladder of management until you receive meaningful assistance. Depending on your state's prompt-payment legislation, remind the payer they may also be liable for interest on claims not paid within guidelines.
Finally, if this still does not provide the desired response, notify the insurance commissioner in your state and file a formal complaint. Usually letting the insurance company know you are aware of the contract guidelines and/or the state regulations and plan to enforce them will often be enough to get your claims paid in a more timely manner.
Note: If your contract does not specify a timeframe in which claims must be paid, request an amendment and have a clause added for timely payment of submitted claims. This can be specified by your state's prompt-payment statute and/or reasonable guidelines agreed upon by you and the insurance company. A suggestion might be 21 days for electronic claim submissions and 30 days for paper claim submissions. Some states require interest be added to claim payments not paid according to state guidelines.
Keep those ASC revenue cycle questions coming! Ask Caryl by emailing email@example.com or fill out the form at the top of this page.
Access archived Ask Caryl columns here.
Never miss a new Ask Caryl by following Serbin Medical Billing's LinkedIn page.