Take the offense to get claims paid
By Michael J. Koch, DC

The insurance game is really just that — a game. The problem is that we take it personally, but the carrier does not.

It’s offense vs. defense — them against us. We send a claim; they say, “We don’t owe you anything;” and we say, “Oh, yes, you do. And here’s why!”

Sound familiar? Your challenge (to win the game) is to know what to do or say to get the claim processed.

1. Send claims with a ‘return receipt requested.’ A receipt proves the claims were sent; especially to carriers you know to use the old “We didn’t get the claim” trick.

2. Make friends with a senior adjuster. Then run all your problems through that person.

3. File electronically. Don’t worry about HIPAA, as all clearinghouses are now HIPAA-compliant. The turnaround time is about from two weeks to four weeks faster than paper delivery, depending on the carrier.

4. Send paper claims in large, flat envelopes. When billing by paper (if you have to), send the claims in large, white, flat envelopes (not standard mailing envelopes). Write on them: “Attention: Claims Dept.”

Tri-folded claims are generally opened in the mailroom and then placed in a paper press for several days so they’ll lie flat on a desk and not flop all over. Strange but true!

5. Never staple claims together. Use paper clips. Make the adjuster’s job easier.

6. One claim, one patient, one day. Put one day’s service per patient on each claim. Trust me, it will be processed by the first adjuster, more than one day, usually gets put on hold, at the bottom of the pile or goes to the next line adjuster, and may go through several days of delay.

7. Organize your claims. Put the most expensive item in the first box (#24) on the claim form, followed by the second most expensive, and so on. These claims get paid faster, with less scrutiny.

8. Try to keep daily charges below $145. Claims get paid faster, with less scrutiny, at this level.

9. Never bill exams and treatment on the same form. And try to avoid doing any exam(s) and treatment on any patient on the same day. Carriers are increasingly disallowing any procedures other than the exam(s), if multiple items are billed the same day.

10. Know how to answer. Don’t take verbal denials lying down. Learn how to challenge adjusters and get a commitment from them without being antagonistic. (See sidebar, “How to talk to the adjuster.”)

If you use these techniques, you’ll score more often — and win for your patients.

SIDEBAR:
How to talk to an adjuster

Michael J. Koch, DC, is president of In-Balance Practice Consulting. He can be reached at 630-420-8759, or by e-mail at drmjkochdc@aol.com.