When it comes to medical billing, denied claims can be a serious pain. But the real problem arises when those denials are ignored and left unresolved. If claims aren’t followed up on or appealed, it results in lost revenue, as time goes by, and you’re left thinking, “I guess the only thing I can do now is just write this off.” Over time, those write-offs add up, sometimes a lot more than you’d like to admit. So, how can you prevent this from becoming a big issue?
The Problem: Denials, Write-offs, and Lack of Tracking
The main issue here is not addressing denied claims promptly. When you allow too much time to pass before following up, you not only risk losing revenue but also risk creating a pattern of uncollected accounts that could snowball. This is especially concerning if you’re dealing with extended days in accounts receivable (AR). Imagine how difficult it would be for a patient to pay a bill when months have passed, and they’re only now hearing about it.
Another significant problem is the lack of tracking systems for denial trends. If you don’t have a system in place to track and analyze those denials, you won’t be able to identify patterns that could help you take proactive steps to reduce them.
Fortunately, we have a couple of solutions to help you avoid these issues. Be sure to watch the video on this article for all the details on exactly how to do all of this.
The Solution: Proactive Claims Follow-up and AR Tracker
One solution involves staying on top of reports and claims submissions as they come in. We’ll get into the details on this shortly, but essentially, staying on top of those reports early on will help you spot issues before they become huge problems. Another valuable tool is AR Tracker, which is designed to help you manage accounts receivable more efficiently. Let’s dive into how these two tools can work together to keep your AR and billing processes on track.
Reading and Managing Reports Effectively
In any medical practice or billing office, it’s crucial to keep an eye on the reports that come in from the clearinghouse. These reports help you stay on top of claim rejections, denials, and other issues that need your attention. The key to success here is early intervention. Don’t wait until months have passed before realizing something went wrong. By staying on top of these reports from the beginning, you can avoid the dreaded “write-off” pile.
The process is straightforward—each time a claim is submitted; reports come back, usually with feedback about whether claims were accepted, denied, or rejected. In Medisoft EDI (eMEDIX), you can set up revenue management to automatically download all your reports into the system. This means you don’t have to go digging through emails or physical files, you can just pull up your reports directly in the program.
Here’s a quick tip on accessing these reports in Medisoft:
- Go to Activities in the main menu.
- Scroll down to Revenue Management.
- Select Revenue Management Reports.
From here, you’ll be able to view the reports that matter most.
Some of the key reports you’ll receive include:
- 835 Files (Electronic EOBs): These provide information on payments made by the insurance carrier.
- 999 Reports (Functional Acknowledgements): These are simply receipts indicating that the clearinghouse has received your claims, but they don’t tell you if the claims were paid or rejected.
- 277 Reports (Claim Status Reports): This is the one you really need to focus on. It tells you whether the claim was accepted or rejected and provides the reason for any denials.
Why the 277 Report is Essential
The 277 Claim Status Report is critical. It will directly tell you if a claim was rejected or denied, and it will specify why. For example, you might see a message like “invalid procedure code” or “denied due to eligibility issue.” If you don’t regularly check this report, you risk letting problems build up without addressing them. That’s why we recommend making the 277 report a regular part of your workflow.
If you haven’t been checking these reports, it’s time to start. Even if you’ve fallen behind, don’t wait for your AR to grow out of control. Take the time to go through your older reports and identify any issues. If you find that there are no rejections, you can archive those reports to keep your workspace cleaner and more manageable. Archiving doesn’t fix any problems, but it can reduce the clutter and make it easier to stay focused.
The Power of AR Tracker: A Live Aging Report
The second solution is AR Tracker, which can help you track and manage accounts receivable in real-time. AR Tracker is a live, interactive aging report that updates as you go, so it’s always current. Unlike traditional aging reports, which become outdated the moment they’re printed, AR Tracker gives you a constantly refreshing view of your AR, allowing you to make adjustments and follow up on issues as soon as they arise.
AR Tracker allows you to view your AR by insurance carrier and sort balances into aging buckets. This means you can easily see which insurance carriers or patients have the largest outstanding balances and prioritize follow-ups accordingly.
When you first start using AR Tracker, don’t worry too much about custom filters. Just click Apply, and AR Tracker will show you a breakdown of your AR by carrier. From there, you can drill down into individual insurance carriers and see which patients have outstanding balances. If you need to prioritize, simply sort by the highest balances, so you’re tackling the biggest accounts first.
Working with Specific Claims
When you drill into an insurance carrier’s account, you can see the details for each patient. For example, let’s say you have a patient under an insurance carrier like Aetna. If you notice a balance that’s overdue, you can call the insurance company directly, reference the patient’s date of service, and ask why the claim hasn’t been paid yet. With AR Tracker, you have all the relevant information at your fingertips, so you don’t waste time hunting for details.
You can also open a specific patient’s case by right-clicking on their date of service and selecting Open Case. This takes you straight to the patient’s case without having to navigate through other screens. Plus, if you need to send the claim back to the insurance company, you can do that with a few clicks.
Delegating Tasks and Improving Efficiency
For practices that have multiple staff members, AR Tracker allows you to assign tasks to specific individuals. For instance, you can assign Joe to handle Aetna claims and Sally to manage United Healthcare accounts. By filtering tasks this way, each team member can focus on their assigned responsibilities, streamlining your workflow, and improving efficiency.
If you want more detailed training on AR Tracker, there are in-depth webinars available through Medisoft University that cover everything from using advanced filters to optimizing your office’s billing practices.
Final Thoughts
Billing and accounts receivable management don’t have to be overwhelming. By staying on top of your reports, leveraging tools like e-Medics and AR Tracker, and ensuring that denied claims are addressed promptly, you can avoid write-offs, minimize lost revenue, and keep your AR under control.
Proactively checking reports and using live, interactive tools will keep you ahead of the game, making sure your office stays on track, and your revenue stays healthy. If you haven’t already, now’s the time to implement these solutions into your workflow—and start seeing the benefits right away.
About Medisoft EDI (powered by eMEDIX)
Medisoft EDI helps billing teams avoid costly mistakes like ignored denials and missed follow-up by automating claim submissions, eligibility checks, and ERA posting—all within Medisoft. With eMEDIX’s real-time tools, you can catch errors early, track every claim, and get paid faster without juggling multiple portals. It’s a smarter, more efficient way to manage your revenue cycle and keep your cash flow steady. Learn more about Medisoft EDI here.
About AZCOMP Technologies
AZCOMP Technologies is the #1 Medisoft dealer in the nation, trusted by more medical practices than any other Medisoft partner. Since 2000, we’ve been helping independent practices streamline their billing, improve patient collections, and get the most out of their software. From expert Medisoft support and training to full-service revenue cycle solutions, we’re here to make your practice more efficient, profitable, and stress-free.
Want to learn more about Medisoft tips, tools, and services that save you time? Visit our blog or schedule a consultation today.
