1. Building rapport with the Insurance Representatives
In an AR Follow-up, while calling the Insurance Company, we need to develop a certain
level of professional relationship with the Insurance Representatives. This would help us
find solutions for cases where the claims have been denied consistently for various
reasons including Global Issues. In some instances, the representatives might even turn
hostile and might not even reveal much of the required information, which could prove
vital in proceeding further on the claims and we have to be very careful in handling
situations like this.
The AR Representative should have strong interpersonal & communication skills and
should be able to make the Insurance Representatives feel comfortable and also should
make the call easy going. Any information, which could help us find the solution for an
issue, should be obtained over the call.
For instance, after a few follow up on the pending claims and building viable working
relationship with a particular insurance carrier, the representative was able to see that
the team was working on legitimate claims that could be worked on. We were asked to
send a fax with nearly 100 claims and the relevant information. The Insurance office
worked on all the claims and reverted back with status information on fax.
Working on Underpaid Claims
The Patient’s Account including the Demographics, Claims & Payment’s history, Follow
up Notes etc has to be analyzed thoroughly before making a call to the Insurance
Company regarding the status of any pending claim. If the Insurance has already made a
payment on a claim and if that payment’s found to be lower than the Contract Fee
Schedule, then this issue needs a special attention, as collectively the balance on the
claims which are underpaid constitute a significant portion of the Accounts Receivable
and this portion can be definitely converted into Revenue. This task could be
cumbersome or complex, but an AR Representative would achieve it, using his/her
experience, knowledge, intelligence & skills. Our team also reverts back to the practice
with changes in the billing guidelines – as in, revising billed amounts – to achieve
maximum value on contracted payments.
When do we call patients?
 When there is no insurance coverage information found in the Demographics Section
of the Patient’s Account.
 When the Insurance Company has denied a claim stating that the Patient is not
eligible for coverage at the Time Of Service, where the Date Of Service could be
prior to the effective date or after the termination date of patient’s insurance
coverage.
 When there is a Patient Balance due in the Patient’s Account.
 When any personal info like Patient’s name, Social Security Number, Date of Birth,
Address etc is found to be incorrect in the Patient’s Account.