Are Unpaid Claims Costing You?

by | Collections, Expansion

How your front office team members collect and handle insurance data makes a huge difference in whether claims are paid or denied. Even the tiniest error in data collection or data entry can result in delayed payment of claims or even complete denial of payment.

Consistent training and in-office organization are critical to a well-run machine, and preventing errors can be the difference between profit and loss. As the owner, it can mean the difference between paying yourself a fair salary and paying yourself a pittance.  

Take a moment to review the statements below and put a check next to the ones that apply primarily to you. In the past three months: 

  • Claims were denied for lack of authorization or lack of a referral. 
  • Claims were denied for incorrect ID number or DOB.
  • We exceeded the number of authorized visits on a case.
  • Claims were denied due to incorrect insurance verification.
  • We had already seen a patient for several visits before realizing we needed authorization.
  • We identified insurance benefits incorrectly, and all claims were denied.
  • I have no idea what is happening with my insurance collections because someone else is completely in charge of it.

Unpaid claims = lost revenue

If you put a check next to any of the statements above, then you’re losing money regularly due to errors and lack of proper training. 

Let’s review several ways an untrained or disorganized front office can result in a failed billing cycle:  

Being in a rush to collect patient demographics and not repeating back what you wrote down.

  • When you’re in a hurry to gather patient information because the phone is ringing or there are other pending tasks, errors will occur.
  • If you don’t repeat back the data you collect, you’ll also increase the risk of error.

Having a cluttered work area. 

  • If the work area is cluttered with different tasks that still need to be done or just overly disorganized, it causes distraction. With clutter and distraction, there will be a significant increase in errors. 

Not verifying the insurance benefits in person. 

  • When you verify insurance benefits through the automated phone or online system, you sometimes receive incorrect information, you only get some of the information necessary, or it doesn’t fully apply to outpatient PT in an office setting.
  • Don’t rely on the automated system for verification; call and speak with a representative.

Not reviewing the insurance card and ID. 

  • You probably scan or photocopy insurance cards and ID, but do you use them when entering data into the system?
  • If you don’t review the card and enter data directly from the card into the patient account and instead rely on what was written on the intake form, you’re creating the potential for significant errors.

Not ensuring that the data entered is exact. 

  • Reviewing the patient data you entered into their online records is key to ensuring that you have it all correct. If you’re in a hurry and enter one key piece of information incorrectly, it will cost you time and money when claims are denied and you need to make corrections and refile claims.

Not reviewing claims before sending them. 

  • Reviewing claims before sending them ensures that all the information on the claim is there and accurate.
  • Of course, if it’s all entered correctly before this step, you’ve already significantly reduced the risk of error-related denials.

No one checks patient accounts regularly to ensure timely payment of claims

  • The sooner you know about a problem, the faster you can correct it. 
  • Since ensuring patients receive the care they need is the primary responsibility of the Patient Care Coordinators, checking EOBs and accounts tends to get set aside until “I have some time,” and that’s a huge mistake. Not being aware of problems can significantly increase your errors and can result in huge financial losses in the long run due to time spent trying to collect or complete denials of claims due to the mistakes.

So, what can you do to prevent common billing errors? 

Have specific systems in place to ensure proper collection of patient demographics. 

  • Have a set form that’s used to collect demographic information when the potential patient calls to schedule.
  • Make sure you repeat to the caller the information you collected to verify it’s correct.
  • Have a verification form that you fill out with specific questions that have to be asked for all insurances. This ensures that nothing is forgotten and everyone collects the same information when they call to verify.

Verify benefits in person, not via an automated system. 

  • Speak to an actual representative and ensure you get your questions answered. You’re more likely to get better patient-related insurance data when you speak to someone.
  • Speaking with someone on the phone will give you the best chance of finding out that a patient needs authorization or an insurance referral.
  • Make sure to tell them what you’re calling about – outpatient physical therapy in an office setting – or they may give you the wrong data (this is what often happens when we use the automated system).
  • Don’t be afraid to hang up and call back – if the person you are speaking to doesn’t answer your questions or doesn’t seem to understand what you’re asking, hang up and call back.
  • Have a set time or day to verify insurance benefits, and when you sit down to do it, be prepared to focus on that. Distractions result in common errors.

Always copy the patient’s insurance card and ID. 

  • Not only are you required to verify that your patient is who they say they are by looking at their ID, but you should also use it to ensure you enter the patient’s correct name, address, and DOB.
  • Entering the information on the insurance card also decreases the risk of errors.

Check and double-check before filing a claim. 

  • First, double–check the original data you entered when creating an account for the patient. Most claim denials occur from someone from errors in keying in basic patient data like name, DOB, insurance, insurance ID #, or group number.
  •  Also, ensure all the other data is correct, like charges, amount billed, and if you have their primary and secondary insurances noted correctly.

Have a specific system to ensure proper payment of claims. 

  • This action tends to get set aside “until I have time,” so some patient records go months without being checked. When you regularly check a patient’s account, you’re more likely to find errors that can be corrected easily.
  • Each patients’ account should be reviewed two weeks after the first claim is filed, at 30 days, and then every 30 days after that if it isn’t a problem case. Problem cases should be checked more often.
  • Handle any denials or errors IMMEDIATELY and stay on top of that patient’s account to ensure no more surprises.

Track authorizations outside of your EMR. 

  • Knowing when authorized visits run out helps to prevent a patient from accidentally going over their allowed visits.
  • Having a system to track patient authorizations will also give you more control over them and help you ensure that you’re requesting more authorized visits in a timely fashion and patients won’t have to wait.
  • As part of your verifications system, if you verbally verify if authorization is needed, you will prevent claims being denied for lack of authorizations.

Prevent unpaid claims through front office training

Front office training and systems are essential to ensure you get paid correctly and on time. The better the systems you have for data collection and entry, the better your billing outcomes will be.  

Don’t discount training your front office team and providing them with systems to ensure they do everything in their power to prevent errors. Responsibility and accountability can only be expected if they have the training and tools necessary to get your desired results.

Want to learn more? Then schedule a FREE Discovery Call to learn more about my programs and how I can help your practice.

Wishing you the best, today and always!



I’m Dee

As a practice owner, former manager, and the Front Office GURU, I understand the difficulties you face because I’ve been there. And my programs provide the solution.

Are you struggling to train your front office team? Unsure how to go about establishing a proven training program for your front desk? Not sure where to start or what your options are?

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At Front Office GURU, we offer two main training options for you and your Patient Care Coordinators.

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