Why should you have a strong relationship with your insurance rep
One powerful tool in the arsenal of any Medical Biller is the business cards of your insurance representatives. How many of you even know who they are? It’s OK. I do not want to embarrass anyone. We are here for education!
When I worked as a biller for an Oral Surgeon in PA, I was very involved with the BC/BS representative. She made personal visits to my office for education and to discuss overdue claims. Once a month she did a lunch and learn about common billing errors. AND…spoiler alert…she was a reference of mine for many years. She admired my ability to hold a claim like a hungry dog with a bone until it was paid or adjusted, whatever the case.
Download the resources on 7 practice management templates which need zero technical skills
Know your insurance representative!
My point here is that you really need to understand who your insurance reps are, YES, for each plan you participate in. You are all assigned to one. Each practice is assigned to a representative. Their main function is to oversee your account and keep the contracts current. HOWEVER, they are also there to answer your questions, assist you with claim analysis and payment and education for your office to assure that you understand the payment policies of that insurance company.
How to catch your rep
If you do not know who your representative is, start small. Call the provider line for the plan in question. Request the name of your representative. Request their direct line. Make time to call them when you have a peaceful time. Usually between 10 am and 11:30 am or 2 pm and 3:30 pm. When you call, if you get their voicemail, leave a short detailed message, include your name, your practice name, your practice insurance participation number (if applicable), and a number you can be reached, repeat the numbers twice in an even cadence. This may sound silly, but research shows that numbers given in this way, can be easily transcribed and more likely to be returned. Then tell them you would like to get more information about the plan.
If you reach them directly or when they return the call, explain to them that you would like to discuss some of the billing challenges you are having. Have examples ready, we all have them. Running reports with the unpaid claims of each insurance will assist you here. Remember, education is more effective when you have done your homework and know what you need clarified for you. Research, research, research,
Create an action plan in advance!
Have an action plan ready, with the holes to be filled in when the education is received. I had the attention of every representative who visited my office when I presented them with an agenda and the action plan to improve our challenge ready for the meeting. This demonstrated two things. We were researching our challenges and we were accepting our part in the changes. These are important to your credibility and the representative’s cooperation. No one wants a challenge presented without the research. Then it just sounds like complaining.
Where to start
If this sounds daunting, don’t let it be. Start with one plan. Pick the one with the most outstanding revenue. YES, this includes Medicare and Medicaid. Dedicate one employee to researching these unpaid claims, or set aside one day a week to allow yourself the time this will need. It will be worth the time when you can see these outstanding amounts get lower.
I even had two representatives who would take the claims back to the office personally to get them reworked and paid. These relationships are important and do help the bottom line of your office. Starting small and keeping communication open will make a difference in the A/R. This is a great tool with powerful results.
