How do you prioritize claim follow-up tasks and workflows?

1 Assess your claim status

The first step to prioritize claim follow-up is to assess the status of your claims. You need to know which claims are outstanding, rejected, denied, or underpaid. You also need to know the reasons for the claim issues, such as coding errors, missing information, or payer policies. You can use a claim management software or a dashboard to monitor and analyze your claim status. This will help you identify the most urgent and important claims to follow up on.

2 Segment your claim portfolio

The next step to prioritize claim follow-up is to segment your claim portfolio into different categories based on criteria such as payer, age, amount, or type. For example, you can group your claims by payer type (Medicare, Medicaid, commercial, etc.), by age (0-30 days, 31-60 days, 61-90 days, etc.), by amount (high-dollar, low-dollar, etc.), or by type (clean, rejected, denied, etc.). Segmenting your claim portfolio will help you allocate your resources and staff more efficiently and effectively.

3 Create and implement claim follow-up policies and procedures

The third step to prioritize claim follow-up is to create and implement claim follow-up policies and procedures. You need to establish clear and consistent rules and guidelines for your claim follow-up process, such as frequency, methods, documentation, escalation, and resolution. You also need to train your staff on how to follow the policies and procedures and monitor their performance and compliance. Creating and implementing claim follow-up policies and procedures will help you standardize and streamline your claim follow-up workflow.

4 Automate and outsource claim follow-up tasks

The fourth step to prioritize claim follow-up is to automate and outsource claim follow-up tasks. You can use technology and tools to automate some of the claim follow-up tasks, such as sending reminders, generating reports, or verifying eligibility. You can also outsource some of the claim follow-up tasks to a third-party service provider, such as a billing company or a collection agency. Automating and outsourcing claim follow-up tasks will help you save time, money, and labor and focus on the most complex and valuable claims.

5 Track and measure claim follow-up outcomes

The fifth step to prioritize claim follow-up is to track and measure claim follow-up outcomes. You need to evaluate the results and impact of your claim follow-up activities, such as the number of claims resolved, the amount of revenue recovered, the percentage of denial rate, or the average days in accounts receivable (A/R). You also need to identify the strengths and weaknesses of your claim follow-up process, such as the best practices, the common errors, or the areas for improvement. Tracking and measuring claim follow-up outcomes will help you improve your RCM performance and quality.

6 Communicate and collaborate with stakeholders

The sixth step to prioritize claim follow-up is to communicate and collaborate with stakeholders. You need to keep your staff, payers, patients, and other parties involved and informed about your claim follow-up process and status. You also need to solicit and respond to feedback, suggestions, or complaints from your stakeholders. Communicating and collaborating with stakeholders will help you build trust, rapport, and satisfaction and resolve claim issues faster and easier.

7 Here’s what else to consider

This is a space to share examples, stories, or insights that don’t fit into any of the previous sections. What else would you like to add?