REIMBURSEMENT: 7 Tips Help You Avoid Computer Claim Casualties

Why This Topic Matters

Processing glitches and delayed reprocessing can create avoidable payment losses and administrative burden. Understanding the article helps billing teams recognize when to investigate denials, verify claim receipt, and pursue unresolved reimbursement issues more effectively.

Article Sections

1. Eyeball Your EOBs

   This section emphasizes monitoring remittance activity for irregular claim outcomes and payment issues. It frames the first step in identifying possible payer-processing problems.

2. Check Your A/R

   This section focuses on reviewing accounts receivable to identify unpaid claims and other outstanding balances. It discusses the importance of follow-up with payers when payments have not appeared.

3. Don't Blindly Believe MACs

   This section addresses communication with MAC representatives and the need to confirm that reported actions are actually completed. It also covers the importance of verifying claim status after follow-up conversations.

4. Keep Timelines in Mind

   This section discusses timing issues in claim processing and the need to understand where delays may be occurring. It also covers concerns that can arise when claims are resubmitted after a system problem.

5. Rely on Web Resources

   This section covers the use of carrier web resources to monitor system issues and status updates. It highlights online information sources that may indicate when claim problems have been addressed.

6. Tackle Snags in Person

   This section discusses escalating unresolved problems through CMS regional offices when payer responses are inadequate. It focuses on moving beyond routine payer contact when necessary.

7. Stand Firm

   This section emphasizes persistence and effective communication when following up on unresolved reimbursement issues. It reinforces the need to obtain complete information before ending payer conversations.