Follow Up on Unpaid Claims and Insurance A/R

You can use PCC’s tools to work on claims with errors, rejections, and denials.

But what if a problem is fixed, but the claim wasn’t resubmitted? Or what if an insurance payor simply never responds? Are some insurance payers regularly failing to pay you in a timely fashion?

You may need specialized tools to find claims that slipped through the cracks and work down your practice’s insurance A/R.

Review Payer A/R Summary (insaging)

Run the Insurance Company Aging Report (insaging) to review an aged summary of your practice’s outstanding charges broken down by insurance group.

You can find out which carriers owe you the most money and how old those balances are. The insaging report is also a quick way to see your total A/R, and it will help you determine which insurance carriers need follow-up attention. For example, if you know that an insurance company comprises a large portion of your outstanding receivables, yet only represents a small fraction of your patient population, you may use that information the next time you review the payor’s contract.

Run and Review the insaging Report

You can find the insaging report in your Practice Management windows.

From the opening configuration screen, press F1 – Generate Report to view the report. (For report configuration options, see below.)

Here is a sample insaging output:

Insurance Company Aging Report                         Generated on 06/01/00
By Transaction date, As of 05/31/00
All Providers
                Current   30 – 59   60 – 89  90 – 119      120+     Total Perc
                   ————————————————————
Personal           3,515     9,410    12,994     9,408    24,342    59,671  32%
Other              7,357       777       399         0         0     8,534   4%
Anthem               361       230         0         0         0       591   0%
Aetna              3,392     2,011         0         0         0     5,403   2%
Aetna/HMO          2,542       171       105         0         0     2,818   1%
Affordable         1,185       497       171         0         0     1,853   1%
BCBS               4,652     1,024       385         0         0     6,062   3%
CIGNA              9,016     1,228       466     1,736     1,846    14,294   7%
HARRIS             1,544     1,015       215        24         0     2,798   1%
HUMANA             5,056       855        89     2,973     1,363    10,336   5%
Medicaid             829        41         0         0         0       870   0%
ONE Health         1,089       782        51         0         0     1,922   1%
PHCS               8,089     2,716       336         0         0    11,142   6%
  .                    .         .         .         .         .         .   .
  .                    .         .         .         .         .         .   .
  .                    .         .         .         .         .         .   .
UNITED             5,897       793       331     3,370     1,685    12,076   6%
                   ————————————————————
Total             69,922    26,034    18,421    20,323    47,055   181,757
Percentage           38%       14%       10%       11%       25%
Total Aging                                                        181,757
Personal Credits across entire practice                             57,127
Medicaid Credits across entire practice                                  0
                                                                ———-
Total A/R                                                          124,629

Your practice’s total outstanding balances are shown with one row for each insurance group. The columns split each insurance group’s total into aging categories. The report includes a “Personal” insurance group for outstanding personal charges.

For group, insaging lists the outstanding A/R that is “Current” or less than 30 days old, 30-59, 60-89, 90-119, and over 120 days old. The total outstanding balance and the percentage of your practice’s total A/R are also listed. At the bottom of the report, you can see the “Total Aging” A/R, along with the total outstanding personal and Medicaid credits (if any).

You can use the insaging report to:

• Evaluate Insurance Companies: If you compare the “Percent” of total A/R column with the percentage figures in the activity report, you will see when an insurance group’s percentage of your total outstanding receivables does not line up with its percentage of your office’s workload. Comparing how hard you have to work to get paid against how many patients you actually see can help you identify “good” and “bad” payors.

• Target a Group that Requires Further Attention: After identifying a payor with a large or particularly old A/R, you can run the Insurance Company Accounts Receivable (inscoar) report to review all the outstanding claims for that insurance group.

Configure and Customize insaging

You can change how the insaging report ages receivables, recalculate aging to a different date, limit the report to a specific provider, and make many other changes.

Here is the options screen you will see when first running insaging:

• Aged How?: By default, insaging calculates the age of your A/R by the “Transaction Date.” You can set insaging to age by “Posting Date”, which is when each charge was entered into your system. This will change the amounts in the report’s aging categories if your office often posts visits long after they occur. Finally, you can choose to age by “Payor Date,” which ages by the date each balance became the current carrier’s responsibility. For example, charges that have recently been forwarded to a secondary insurance will appear as “Current” even though the visit occurred months ago.

• Aged as of what date?: Since aging calculations involve every charge on your system, they are performed each night and stored in a “Nightly File”. insaging uses the previous evening’s Nightly File by default. You can tell insaging to regenerate a file representing unpaid charges aged to any date you prefer. Once you have regenerated an aged nightly file, you can select that report again by choosing the “Use Existing File…” option.

• Destination: Choose whether you want to view the report on your screen, mail it to your e-mail inbox, or print it on a specified printer.

• When To Run: Run the report “Right Now” and have your terminal wait for the job to finish, run it “In The Background” so you can go on and do other things at the same time, or schedule the job to run “Later At” a specified time. This option was useful on older computer systems (pre-2003) and should no longer be needed.

• Generate...: You can include charges for all providers, or select individual providers or a provider group. PCC can help you set up any provider group you would find useful for A/R Analysis. All credits are assigned (by default) to the Office provider. If this provider is not included when the report is run, then no credits will be reported.

Understanding and Configuring Insurance Groups

The insaging report tallies charges by the plan they are pending. Charges that do not pend an insurance company are totaled in the Personal line of the report.

If you see a blank line in the middle of the insaging report, there is an active insurance group in the Table Editor (ted) with no plans assigned to it.

Use the byins program to review how your insurances are grouped. Edit your Insurance Companies and Insurance Groups tables in ted to re-group plans if necessary. For example, you may want to consolidate two insurance groups with very few plans and little activity, or you may choose to break up an insurance group if it represents a large portion of your business and you want to track it more closely. For more help creating and organizing insurance groups for reporting purposes, contact PCC Support.

Work on Unpaid Claims (inscoar)

While you can use workflow tools to address claims with errors, rejected claims, and denied claims, you may want to work with a list of all unpaid claims, regardless of billing status. To work claim-by-claim on your practice’s unpaid, pending charges, use the Insurance Company Accounts Receivable (inscoar) report.

The inscoar report also includes an interactive mode, which allows you to research billing history, make changes, and then resubmit claims all from the same screen.

Run and Review the inscoar Report

You can find the inscoar report in your Practice Management window.

From the configuration screen, press F1 – Generate Report.

Every account with unpaid insurance charges appears on the report. The accounts are sorted by the insurance company to which their charges are pending. inscoar shows you the insurance company’s name and phone number. With each account name, you can see the family’s insurance ID number and group number. The patient name, procedure dates, names, codes, and primary diagnoses codes are all shown, along with the outstanding balance information.

• Visit Notes and Billing History: If there are any Visit Notes, they will appear under the first charge for that visit. If there is any billing history, it will appear under each charge. If a claim was generated, you will see a billing message with batch information and the total original amount of the claim.

• Contact Insurance Companies about Unpaid Claims: Because the inscoar report shows insurance ID information, full procedure information, and the insurance company’s phone number, along with the original amount of the claim, inscoar is a great report for working down old, unpaid claims.

• Jump to Other PCC Tools for More Information or to Resubmit: With the interactive inscoar report option, you can jump straight from this report into more information and different Practice Management tools, making inscoar an even more powerful insurance billing tool. See Below.

Configure and Customize inscoar

You can choose the age of receivables you wish to review, limit the report by insurance company, provider, or place of service, and make many other configuration choices that change the output of inscoar. Here is the options screen you will see when first running inscoar:

Output Options for inscoar

• Send report to:

  You can view the inscoar report on the computer screen, print it out, or have it sent to your e-mail inbox. You can also view the report as an “Interactive Screen,” which allows you to work on the charges as you review them.

Criteria Options for inscoar

• Age of Receivables:

  You can limit the inscoar report to only those charges that are over a certain age, those that within a certain age range, or those that occurred during a specific date range. Using these options, you could, for example, choose to view only insurance charges that are nearing the end of a particular carrier’s timely filing limit.

• All Insurances?

  If you enter “No,” you will be prompted to select insurance plans or groups that you wish to view. Otherwise, you will see all insurance plans that have outstanding charges. This option is useful if you are dealing with a particularly poor payor.

• All Servicing Providers?

  If you enter “No,” you will be prompted to select providers or provider groups for which you wish to view charges. The default of “Yes” will run the report for all providers that have any outstanding charges.

• All Places of Service?

  If you enter “No,” you will be prompted to select the place of service for which you wish to view charges. The default of “Yes” will run the report for all places of service for which there are outstanding charges.

• Include Personal Charges?

  Change this item to “Yes” if you wish to view all charges, regardless of whether they pend an insurance carrier or are the guarantor’s responsibility. In this way, you could analyze personal charges at the same time as insurance charges.

Formatting Options for inscoar

• Show Visit Notes?

  Change this item to “No” if you do not wish to view Visit Notes. A visit note is added to charts in the Correct Mistakes (oops) program.

• Show Billing History

  Change this item to “Yes” if you want the date the charges were batched or submitted, along with other billing messages, to show in the report. This may be useful when dealing with old charges that have been resubmitted several times.

• List Insurances with no pending charges?

  inscoar can create a list at the bottom of the report of insurance plans that meet your criteria but do not currently have any outstanding charges pended to them. Keep this option as “No” to suppress the list.

• Suppress page breaks when printing?

  Change this field to “Yes” if you wish to print the report in one long section. By default, inscoar prints different insurance plans to different pages for your convenience.

• Extra Information To Show:

  Use these settings to show the information from the four boxes in the Patient Editor (notjane) on the report. For example, if your office stores insurance ID# information in one of those boxes, it may be useful to have that information on your inscoar report.

Use Interactive inscoar to Work On Claims

Use the Interactive Screen in inscoar to work on claims. While reviewing unpaid claims, you can research account history, correct and resubmit problem claims, and add notes to the patient or account.

To access the interactive features of inscoar, check off the “Interactive Screen” option on the configuration screen:

As with other output settings, you can modify the other options on the screen, such as the “All Insurances?” option, to limit what portion of your A/R you will view interactively.

When you run the report, you will notice new fields and functions:

Every item on the report, whether an insurance company, an account, a patient, or a charge, has a selection box at the left hand side of the screen. Function keys at the bottom of the screen let you show or hide additional information, work with an item, or move around the report by searching.

Show More Info

When you select an item and press F1 – Show MoreInfo, the report expands to include additional information about that item. For example, if you select an account and press F1, you will see all of the account’s contact information.

When you select a procedure and press F1 – Show MoreInfo, you will see information about the charge.

If you then select “View Charge History” and press F1, you will see billing history messages about the charge:

Press F2 – Hide MoreInfo whenever you wish to collapse or hide the extra details.

Work With Entry

What if you call the insurance company about a claim listed on the report, and they want to know more details about the patient? What if they explain the problem, and you then need to correct a diagnoses code and resubmit the claim? You can do all of this from within interactive inscoar by using the “Work With Entry” function. You can also use this tool to access information about any patient or account listed on the report.

To start, select any item on the screen that you wish to work with. Then press F4 – Work With Entry.

What can you do when you select an item and press “Work With Entry?”

• Insurance Plans: Select an insurance plan and press F4 to view the plan’s entry in the insurance table in ted, the Table Editor. From there you can review plan information, claim batch, plan notes, and other data.

• Account Name: Select an account name and press F4 to run the Family Editor (fame). From there you can view collection and account history reports, add notes about your interaction with the insurance company, review insurance information, and perform many other functions.

• Patient Name: Select a patient name and press F4 to view an interactive “Patient Information” screen.

  From this screen, you can do the following:

  • Select any item listed and press F1 – Show MoreInfo to view further details.
  • Press F3 – Edit Patient to run notjane.
  • Press F5 – Imms Record to jump straight to the patient’s immunizations.
  • Press F6 – Schedule Patient to run sam, from which you can schedule a new appointment or review past and upcoming appointments in inquire.
  • Press F7 – Patient Forms to generate form letters for the patient.

• Procedures: Select a charge or procedure and press F4 to view an interactive “Visit Information” screen.

  
  
  
  • Select any item listed and press F1 – Show MoreInfo to view further details. This is especially useful when viewing existing billing messages in the “Billed/Payment History” section shown above.
  • Press F3 – Refund to run refund. You can use refund to post refunds or any accounting adjustment that takes money away from an account or increases its balance.
  • Press F4 – Pam to run pam, the Payment Posting program. Use pam to post personal payments or any accounting adjustment that reduces its balance.
  • Press F6 – Correct Mistakes to run oops, the Correct Mistakes program. Use oops to modify charge information, such as diagnoses and claim information, as well as for printing or batching a new claim.
  • Press F7 – Post Charges to run checkout, the Charge Posting program. Use checkout to post additional charges or repost a charge that you deleted in oops.
  • Press F8 – Family Editor to run fame, the Family Editor. Use fame to review account history, insurance policies, or other account information.

Go Back: When you are finished working with an entry, press F12 to go back one screen. You can repeatedly press F12 and move back through each screen, all the way to the original inscoar configuration screen.

Search the Report

Depending on the criteria you used, your Interactive inscoar report may be very long. Use the four search function keys (F5 through F8) to navigate the report and jump directly to the account or insurance with which you wish to work.