Medical Billing Forum

General Category => General Questions => Topic started by: maryanashaban on November 23, 2015, 03:12:35 PM

Title: Non paid claims
Post by: maryanashaban on November 23, 2015, 03:12:35 PM
I have a general question.

Some billers say that there are 1%-2% non paid claims per calendar year, some say that all claims have to be paid.

Is that common to have non paid claims that clinic has to write off?

We are a medical clinic (we have two family practitioners) and there are some claims that its impossible to get paid, and we can not bill patient.


Can you please share your experience and thoughts regarding this question.


Thank you
Title: Re: Non paid claims
Post by: RichardP on November 23, 2015, 03:33:49 PM
Can you give a bit more information on who is not paying the claims and why they are not paying?
Title: Re: Non paid claims
Post by: maryanashaban on November 23, 2015, 05:37:25 PM
We have  claims where we billed insurance, they don't pay because for some reasons they didn't get a claim, we send them proof from clearing house but they still don't pay,  we have to call 3-4 times until it gets paid, or for some reason in their system  shows that a patient was not active when patient was, they check and promise they will reprocess a claim but they never do, we have to call many times, we spend a lot of time calling on those claims. We don't bill patients, so I am thinking maybe we should.
Title: Re: Non paid claims
Post by: kristin on November 24, 2015, 08:29:41 AM
We have a few claims a year where things like this happen. We will fight on behalf of the patient to get the claim paid to a point, but if insurance is still not paying, at that point we bill the patient and let them know why the claim was not paid. This is clearly outlined in our financial policy that all patients sign. 9 times out of 10, once the patient starts calling the insurance company and arguing, the claim is then paid. We never write-off unpaid claims unless WE were in error somehow.
Title: Re: Non paid claims
Post by: Cpatel on November 24, 2015, 09:49:23 AM
I agree with Kristin. We never w/o either unless it is error on Physicians part or if Physician want to take off. Payer should accept timely filing proof from the clearing house unless if any discrepancy on Tax id or NPI. About patient, best thing is to involve patient and payer will fix patient account immediately. We do not give up from calling payers multiple times to get claims paid.
Title: Re: Non paid claims
Post by: PMRNC on November 24, 2015, 01:36:52 PM
Quote
We are a medical clinic (we have two family practitioners) and there are some claims that its impossible to get paid, and we can not bill patient.

I suggest doing an analysis so you can determine common denominators to help you maximize reimbursement. You don't say how many but if there are many and you can't bill patient, I suggest looking very closely at your carrier contracts, make sure you are utilizing ABN's properly, and look for possible coding problems. Once you identify your problem areas you can then move forward and reduce denials.
Title: Re: Non paid claims
Post by: Jdave111 on November 30, 2015, 02:28:12 PM
maryanashaban, What state is the provider located in? For example there might be applicable laws whereas the insurance must pay the claim, with interest and penalties! California has such laws AB1455.