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Teresa Duncan, MS, FADIA, FAADOM is an international speaker who focuses on revenue, dental insurance & management issues. She is a Fellow of the American Association of Dental Office Managers. Her memberships include the Association of Certified Fraud Examiners, National Speakers Association and the Academy of Dental Management Consultants. She has been named one of the Top 25 Women in Dentistry by Dental Products Report. Teresa received her Master’s Degree in Healthcare Management.
The insurance aging report is one of the least favorite reports for administrators to run, but is so important for keeping up your practice’s cash flow.
The time it takes to work this report is considerable and if it hasn’t been recently run then it is an even more daunting task. Unfortunately, I’ve seen team members overwhelmed because they were tasked with cleaning up an incredibly long list of unpaid, untracked and sometimes unsubmitted claims.
Ideally the report should reflect mostly claims that are current (0-30 days). If you have claims in the 30-60 day aging group, you should look to see how many of those are secondary claim submissions. Are they not secondary claims? If your over-30-day claims are higher dollar amounts, then it’s very possible that attachments were not submitted or additional information was requested. I would love for the number of claims that are over 90 days old to be zero. A well-run insurance process will reflect in this category being a lonely, unoccupied column. I like it that way!
Follow up on your oldest claims first since you may run into timely filing deadlines. This means that you only have between 90 days to 15 months from the date of service to submit your claim. Check your contract to find out what your deadlines are. I find that the majority of them are 12 months.
When you are faced with an overly long claims aging report it is because of one of two reasons: Operator error or an underperforming claims clearinghouse. Let’s talk about the first reason, the person(s) in charge of your insurance system. Is he or she properly trained? When I ask doctors this question they often tell me that “she’s doing it for years so I hope she knows what she is doing” or “I’m not sure what he does to keep up with the process.” Neither of these are comforting answers.
An insurance administrator who says they are an expert and doesn’t need to take any classes or read through any current manuals is fooling him or herself. The plan designs and contractual language have changed so dramatically in the past five. At minimum, a new coding guide should appear in your office annually (the codes are updated yearly now), but ideally the insurance coordinator should pursue live or webinar training to keep up with industry changes.
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If you are continuously resubmitting claims that the insurance company claims to have never received then you should reach out to your clearinghouse to let them know. You pay for their services so you should let them investigate as to why your claims are not reaching their destination. This would also include double-checking your information with the clearinghouse. Do they have your correct tax identification number (TIN), National Provider Identification number (NPI) and any other specific plan identifier, if applicable? Many of our clients find themselves switching clearinghouses if they are not happy with their questioning of the company.
Is it your in-office process or is it your vendor? Whatever the reason, it is time to take action if your aging report is uncomfortably lengthy. Is this report new to you? Be prepared to run this every week so that you can work through it slowly and leave yourself notes. Many claims will need to be investigated and you won’t remember every customer service representative or conversation you’ll have. If you’re a long-time insurance coordinator like me you definitely will need reminders! Once you have worked the report regularly and are familiar with the names and situations you can begin a bi-weekly schedule.
Working an insurance aging report does not mean resubmitting claims over and over again. You will need to put some phone time into it, either to the insurance company or the clearinghouse. Don’t be discouraged however; running the report to discover the opportunity for cash recovery is half the battle. Imagine how much revenue is lost when you don’t track outstanding claims and requests for information. Reports are not just a tracking mechanism, but are insight into the health of your practice. Don’t you want to know the condition of your cash flow? Run the reports!
About the author
Teresa Duncan, MS, FADIA, FAADOM is an international speaker who focuses on revenue, dental insurance & management issues. She is a Fellow of the American Assn of Dental Office Managers. Her memberships include the American Academy of Dental Consultants, National Speakers Association and the Academy of Dental Management Consultants. She was recently named one of the Top 25 Women in Dentistry. Teresa received her Master’s Degree in Healthcare Management.