If you’re new to ImagineSoftware or have employees that are, you may need a refresher (or recommendations) on how to best utilize your insurance and denial ticklers for maximum effectiveness.
While each practice assigns ticklers differently, most assign by insurance carrier. However, there is no “right” way to assign your ticklers—some will argue that by assigning by carrier each rep becomes an “expert” in that insurance making them a more experienced and effective employee. Other practices may assign by alphabet, regardless of insurance carrier--arguing it makes for a more well-rounded A/R rep and you are less affected if an employee leaves the company. The alpha-sorters usually also claim their employees are “less bored”. Either way, there are rules of thumb that apply to either methodology when sorting and working the ticklers.
Sort #1: Date of Service
Do a reverse sort by date of service by clicking the top of the date of service column twice so the oldest date will appear at the top of the list. By doing so on a frequent (recommended daily) basis, you can avoid costly timely filing denials.
Your reps should be well-versed in the timely filing requirements for each carrier (regardless of how they are assigned to their respective workloads) for both initial filing limits and for appeals. If you have an Intranet or shared drive, documentation of timely filing requirements provide a good resource guide to keep for new employees—best not to leave these to oral history.
Sort #2: Balance Amount
The next most important sort is most definitely by balance amount. Again, double click the balance amount column to get the largest balances on the top and work from there. Set a threshold for your staff to work, for example, anything above $500 each day (for hospital-based practices) and try to get through all those accounts, if possible.
Sort #3: Denial Type
The best way to accomplish this sort is to arrange for a “spot” review first and then filter. Again, sort by clicking the denial column and start scrolling down. Do you have a lot of one category of denial you can attack all at once? If so, utilize your tickler filter to isolate that denial code and get to work by either logging in to the payer website or utilizing the batch print letter function to appeal a group of denials. Sometimes it helps to get into “eligibility” mode or “duplicate” mode and knock them all out at once.
Build ticklers into your staff’s workflow by insurance, patient, denial & more.
Carve out a day or so each week or two to make sure secondary claims are worked. There is much to be learned from secondary claims sitting in the insurance tickler for one reason or another. You can find out which claims are not on automatic crossover from Medicare, what payments you might be able to receive electronically that you’re not already and for what scenarios you might be able to write a rule. For instance, if both primary and secondary are commercial and you know one will not cross over to the other—write a rule to make sure the claim does not just sit there…unpaid.
Finally, it can be easy to get hung up on the charges with no charge action/date on them for follow-up. However, it is important to pay close attention to those that do have follow-up dates but are still in your tickler because there is most definitely something wrong with them. Those charges present an opportunity to make your A/R reps better at their jobs. There are a number of potential reasons the charge will remain in the insurance tickler after being worked, but often times there was just one extra step that needed to be made to resolve the account once and for all. (Asking for a fax of an EOB, for instance, instead of assuming it would show up in the lockbox.) There is a lot to be learned—and money to be made—from “comeback” accounts, so do not ignore them.
There is no one, “right” way to work your ticklers, but these three sorts should improve productivity and/or the ability to better identify process problems so they can give you the most bang for your buck.