In all medical practices physicians want to receive payment from the insurance companies, but rejections are not a bad thing, they can give you information that is to your benefit.
In the medical office most physicians, directors, and office managers do not like rejections. They feel that something is wrong with the biller, this is not always the case.
Truth be told there are many reasons that a claim could be rejected—previously paid, patients has other insurance, wrong procedure code, the claim needs a modifier, patient information does not match. These are just a few out of may more out there.
Rejections are not a bad thing if they are worked immediately by your biller. A rejection 95% of the time can be re-worked, sent back to the insurance company and you will be paid. If the rejection states that the patient does not have that insurance—that is also not a terrible problem since those charges then need to be transferred to the patient and if that patient gave you the wrong information, then that patient wil contact you immediately because most patients’ do not want a bill hanging over their head.
There is only a small percentage of these rejections that are not payable from either the insurance company of the patient.
If the rejections in your practice are not being worked then your business is losing money. Your biller needs to be able to bill charges out, post payments, work your rejections and also work on your account receivable report on a weekly basis. If these things are not being done properly then your practice is losing money.
If you are not sure that your biller is working all the rejections, you need to run an accounts receivable report. Look to see what claims are older than 30 days and the amount. Most A/R reports show 30-60-90-120 days old. If you have a high balance on anything from 60 days on your A/R report then your practice has a problem and it needs to be corrected as soon as possible. This is your income just sitting out there not being paid.
If you are not sure you can hire a consultant company to come into your practice and have them review your A/R report and help bring your business and income back to where it should be.
Remember that this is your money and your furture. Make sure you have either the a biller with experience or make sure that you have a very experience billing service.
Whatever you decide to do I wish you the best of luck. Just remember that anything that is not in proper working condition can be fixed.
Mary Owston is a professional medical biller and has been for 30 years. She has experience in numerous specialties. Mary Owston is the founder of MBC Medical Billing Company, LLC and may be found at http://www.mbcmedicalbilling.com
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