Every biller knows the feeling: a claim submitted weeks ago, still unpaid, sits in limbo. It can represent thousands, even tens of thousands of dollars in lost revenue if left unchecked. Claim follow-up isn't just a task. It's one of the most important parts of revenue cycle management (RCM).
The Importance of Systematic Claim Follow-Up
Claims don’t always get paid promptly. Payers delay, deny, or simply overlook them. Without rigorous follow-up, small issues snowball. Practices might see their accounts receivable (A/R) balloon to uncomfortable levels. Worse yet, the chances of collecting those older claims diminish significantly over time.
Why? Because every day a claim ages, the likelihood of recovery decreases. Payers have little incentive to pay quickly if they're not pushed. And let's be honest—many payers count on providers not following up aggressively enough. Falling behind means leaving money on the table.
Building an Effective Follow-Up Process
An effective follow-up process starts with organization. But it doesn’t end there. You need a system that’s disciplined and relentless. Let’s break it down.
Prioritize Your Claims
Not all claims are created equal. Start by categorizing them based on aging buckets—30, 60, 90 days, and beyond. Claims older than 90 days need immediate attention as their recovery probability drops sharply. A $5,000 claim that’s 90 days old is more urgent than a $100 claim that’s 30 days old. Prioritize accordingly.
Track Everything
Use your billing system to meticulously track submission dates, follow-up actions, and payer responses. This creates a paper trail that’s essential for accountability and audit purposes. If a payer claims they never received a follow-up, you can point to your records.
Establish a Follow-Up Timeline
Set up specific intervals for follow-up. A common practice is to contact the payer every 14 days until a claim is resolved. This doesn’t just keep the claim on their radar—it makes clear that you’re serious about resolution. Some payers have been known to expedite claims for persistent providers.
Use Multiple Channels
Don’t rely solely on phone calls. (Though nothing beats a direct conversation for clarity.) Payer portals, emails, and faxes are all valid channels. Each has its quirks. Some payer portals allow you to submit reconsiderations directly—use this to your advantage.
Know the Payer’s System
Some payers require specific forms or documentation for status updates. Others might need a reference number from their portal. Familiarize yourself with each payer’s requirements to avoid unnecessary delays. Aetna and UnitedHealthcare, for instance, have notorious portal systems with unique demands.
Document Everything
Take detailed notes of every interaction with the payer. Record the date, time, representative’s name, and a summary of the conversation. This isn’t just for your benefit. When (not if) you have to escalate an issue, detailed notes are your ally.
Escalate When Necessary
If a claim languishes without resolution, escalate it. Ask for a supervisor. Reference your documented follow-ups. In some cases, you might need to involve your credentialing team if the issue relates to provider status. Don’t wait too long to escalate—payers often stonewall until you push harder.
Overcoming Common Challenges
High Volumes
Handling a large number of claims? It’s inefficient to tackle them one at a time. Batch similar claims for follow-up. Use automated tools to flag claims that match certain criteria, like specific denial codes (e.g., CO29 for missing documentation).
Staff Turnover
New billers may not be familiar with payer policies or the intricacies of your follow-up process. Regular training is key. Pair new hires with experienced staff during their initial months.
Keeping Staff Motivated
Following up on old claims isn’t glamorous, but it’s necessary. Encouragement can be as simple as highlighting successful recoveries in team meetings. This keeps the team focused on the value of their efforts.
The Role of Technology
Automation and analytics can revolutionize follow-up processes.
Automate Routine Follow-Ups
Use your RCM software to automate reminder emails or alerts for follow-up dates. This reduces the cognitive load on your team and ensures nothing slips through the cracks.
Leverage Analytics
Data can identify patterns in denials or delays. If claims from a specific payer consistently stall, you can address systemic issues with targeted strategies.
AI Assistance
With tools like Arrow, AI can take over repetitive tasks, freeing your staff to handle complex issues. It can suggest follow-up actions based on past data, making the process not just faster but smarter.
Final Thoughts
A systematic follow-up process is indispensable for effective A/R management. It requires diligence, organization, and sometimes, a fight. But the payoff is real—a healthier bottom line and fewer headaches down the road. Investing in a robust system is not just wise. It's essential.
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