This is the area where the rubber meets the road. Just about anybody can get a claim out the door. It's what happens afterwards that makes the difference.
This is also the number one failure in in-house billing departments. Many billing companies aren't much better. If you're considering using a "bargain" billing company, then this is the one place your billing will suffer. Billing companies must submit your claims.. they must post your payments (otherwise the billing company doesn't get paid)..... the only place that a billing company can "cut their cost" is by under-staffing your account in the area of denials, appeals and A/R followup.
Denial Tracking
Health Data Solutions tracks your denials until they are paid. Using a unique "tickler" system, the denial is posted at the time of your payments. A skilled staffer works the denial, and sets future actions and followup dates. Tracking your denials this way gives us trending detail that we can compare across all of our practices, groups of practices, from provider to provider within your practice, and other practices outside our immediate client base.
Appeals
Yes, we appeal claims. Lots of them. Sometimes this can be as simple as a "carrier re-opening" of a claim. Sometimes we've had to get the Insurance Commissioner involved. We've paid payers a personal visit, with an armload of problem claims. We've taken claims to second-level appeals with Aetna, Blue Cross, Acordia PEIA, Workers Comp, Medicare, Medicaid and more. We get patients involved when we have to.
If we're getting a lot of similar denials, we prepare a "packet" of appeal materials. Every denied claim gets this packet attached and out it goes. After awhile, we tend not to get that denial anymore. :) This is the fun part of the job for us.
No-Pays and Slow-Pays
Every morning, our collectors get a worklist for the day. These are claims that we haven't received a response from the payer, or we've worked it once before and we set a "tickler" so it would be worked again if it wasn't paid when the payer promised. These worklists are populated based on parameters that we set, based on expected "usual" payment times by payers (if there is such a thing.) Most of these are set to trigger every 30 days. So your claims are worked constantly. We also prioritize claims by payers with shortened timely filing deadlines, as these claims are at a higher risk not to be paid.
No-pays are the claims that just seem to disappear at the insurance company, as in "we don't have that claim." Slow-pays are claims that get hung up, but aren't necessarily denied... likely, they are "pending review." If these claims aren't systematically followed up on, they'll never get paid. We have a process in place for nearly every kind of obstacle, and the result is, more payments for you, faster.