Strategy Review
In most cases insurance companies have 45 days to process the claim once they receive it. Key words, process, and receive. Remember, they make up to 50% of their profit from interest earned on your money. Not just premiums they have collected from patients. The insurance company strategy comes in four basic flavors.
- Delay claim submission
- Prevent claim submission
- Prolong the “processing” time.
- Take the money they paid back from the doctor.
Now we know their motivation. If you look at the chart below it is pretty obvious. What tactics to they use to make it happen?
Tactic # 4 – Complicated Submission Process
Forget getting the coding correct. Even if you have that correct it is difficult just to get the claim physically to them. Quick, tell me 10 fields on a HCFAA form. Have you ever heard of CCI edits or LMRP. I won’t bore you with the details here. Google them. The point is there are so many fields and rules for a reason. Get one number wrong and you are delayed. Clearing houses can help automate some of this by checking for some of the submission errors up front. When you want to go to electronic billing you need to find a clearing house. Then you have to “enroll” with each insurance company to submit through the clearing house. Good luck figuring out that process. If you submit by paper there is no way to confirm the claim was received at all. There are a certain percentage of claims where you are told “we never got it”. Imagine telling your mortgage company you never got the bill. Delayed. Then the form has fifty plus fields. If you make on error or transpose one digit on a birth date, it is denied and delayed. If you make multiple errors it is not spelled out like that on the EOB, they only tell you about one error at a time. Even with clearing house scrubbing you are still left with a lot of errors that can prevent and delay payment. Then there are secondary and tertiary carriers. Appeals process in multiple levels.
