ACCOUNTS RECEIVABLE FOLLOW-UP CRITERIA

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Barry Townsend
5 years ago
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1 Patient Balances Argus Billing Office follows the following criteria when dealing with patients balances. Argus Business Office will send five (5) statements; one (1) collection letter and will make one (1) phone call to patients. o Argus will call the patients on accounts with balances over $ o Argus will call the patients on accounts with balances over $50.00 where we have no insurance on record. o Argus will not call the patients, if the balance is under $300 and the services were paid/adjudicated by a carrier or partially paid by the patient. After 120-days, the account is either adjusted off or sent to an outside collection agency. Small Balance Write off Self Pay or Insurance Balances Accounts with balances under $20.00 will be adjusted off once account reaches 120-days (This applies to total balance on the account- not line item). Medicare The following activities will occur to ensure Medicare payment is received in a timely Argus will bill the claims to Medicare within four (4) days of receiving the superbill. For ProHealth & Clients using the Argus PO Box: A/R staff will do the follow up at (45) days from date billed date and every (45) days thereafter. For Clients not using the Argus PO Box: Argus will do the follow up at (61) days from the "billed date" and (45) days thereafter. Medicare Cross Over Claims Medicare will usually cross over the claims automatically. In the event that Medicare does not cross over the claims, Argus Business Office will cross over to secondary payers within 5 days after receiving the Medicare payment. A/R staff is to follow up crossed over claims in 45 days and every 45 days thereafter. Page 1 of 5

2 Medi-Cal The following activities will occur to ensure Medi-cal payment is received in a timely Argus will bill the claims to Medi-cal within four (4) days of receiving the superbill. For ProHealth & Clients using the Argus PO Box: A/R staff will do the follow up at (45) days from date billed date and every (45) days thereafter. For Clients not using the Argus PO Box: Argus will do the follow up at (61) days from the "billed date" and (45) days thereafter. CEP and CHDP The following activities will occur to ensure CEP and CHDP payment is received in a timely Argus will bill the claims to CEP and CHDP within four (4) days of receiving the superbill. A/R staff will do the follow up between 61 days from the date billed date and every six (6) weeks thereafter. PPO Carriers The following activities will occur to ensure PPO Carriers payment is received in a timely Argus will bill the claims to PPO carriers within four (4) days of receiving the superbill. A/R staff will do the follow up at sixty one (61) days from the date billed date and every 45 days thereafter. A/R staff is to follow-up crossed over claims in 45 days from the date when the primary insurance paid and every 45 days thereafter. HMO Carriers The following activities will occur to ensure HMO Carriers payment is received in a timely Argus will bill the claims to HMO carriers within three (3) days of receiving the superbill. Page 2 of 5

3 A/R staff will do the follow-up at ninety one (91) days from the date billed date and every 61 days thereafter. Note: Some Medi-cal managed care payers take longer than 91 days to process the claims. This is the case for Community Health Plan. The follow-up for this payer will be done at 120 days and every 120 days thereafter. Workman s Compensation The following activities will occur to ensure Workman s Compensation payment is received in a timely Approved Claims Only (Authorized by the employer and W/C carrier) Argus will bill the claim to the workman s comp carrier within (4) days from receiving the superbill. A/R staff will do the follow up at 61 days from the date billed date and every 45 days thereafter. Down Coding In the event a carrier down codes a CPT code, the payment department will post the money to the line item. No adjustment will be allocated. The payment department will forward a copy of the Explanation of benefits to the Accounts Receivable Department. The A/R Department will investigate and take proper steps to find out reason for down coding. Denied Procedures Argus will ensure that procedures that are denied payment will be investigated thoroughly. In the event an explanation of benefits indicates that a procedure was denied for any other reason besides non-benefits, the payments department will forward a copy of the denial to the A/R department for investigation and follow-up. Denials should be worked by our Accounts Receivable team within 15 days from the denial date. Procedures Paid at a Low Rate The following activities will occur in the event a claim is reimbursed at a low rate. Page 3 of 5

4 Different profiles are set within the Optum PM system. In the event a claim is reimbursed at a significant low rate, the payment department will compare the paid amount to the Medicare/Cigna fee schedule. If a charge is reimbursed at a significant low rate, the explanation of benefits is forwarded by the payment department to the Accounts Receivable Department. The A/R staff will investigate and take proper steps for additional payment. Bundled Procedures The following activities will take place in the event a procedure is denied/bundled with another service performed on the same day. The payments department forwards a copy of the denial to the Accounts Receivable Department. The Accounts Receivable Department reviews the current Medicare Correct Coding & Payment Manual. If a charge if found not to be bundled, the A/R staff takes proper steps to appeal. Appeals Argus will appeal any denied services. The charge balance to be appealed must be $100 or greater, except: o Timely filing: Claims denied due to timely filing when the charge is greater than $50, Argus will send one appeal as long as we have proof that the claim was originally filed on time. CareTracker Rejected Claims Claims Edits: CareTracker has scrubbers in place. The system will not let a charge get billed if is missing information (example: missing address, gender, insurance ID etc). o Offices doing own demos: Office staff is responsible for fixing denials due to demographic errors within 5 days from the denial date. o Offices doing own charge entry: Office staff is responsible for fixing denials due to coding related errors. Missing Information: When a claim is denied by the carrier due to missing information (example: Authorization), our staff will fax/ the request to the office. The claim will Page 4 of 5

5 be moved to CareTracker Missing Information bucket. The office staff is responsible for reviewing this bucket once per week. Payer Edits: Payer Edits are claims denied by the insurance companies. These denials will be worked by the Accounts Receivable Dept. within 15 days after receiving the denial. Personal Injury Accounts Argus will bill the claims to the attorney or to the Med pay-auto insurance carrier within three (4) days of receiving the superbill. If claim is out to the Med pay auto insurance carrier, A/R staff will do the follow up at 91 days and every six (6) weeks thereafter. If the claim was billed to the attorney, A/R staff will contact the attorney s office at 91 days and every 3 months thereafter. Page 5 of 5

Please submit claims and encounters electronically via Office Ally at

Please submit claims and encounters electronically via Office Ally at Claim Submission All claims must be submitted within 90 calendar days from the date of service for contracted providers unless otherwise stated in the provider service agreement. Please submit claims and