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foreign [Music] hello hello and welcome to Medical billers Network live how's everybody today I hope you guys are all doing well and being safe out there us on the East Coast we are all either having recovered from this storm that's blazing through here or Bridge into your town or you are preparing um we in the Carolinas are preparing for the storm that is coming so today's going to be short and sweet I have a few things that I got to get done before we are hunkered down tomorrow in our house I want to know from you guys what's going on in your world as you get here tell us that you are here let me know where you're joining in from and today your question of the day is what is your favorite holiday um favorite holiday I love it when I pick a question that I don't know if I have a good answer for I'm gonna be so corny and say that my favorite holiday is not really technically a holiday but it's my holiday it's my birthday I'll say that my birthday is my favorite personal holiday and I will call that what I like to call my birthday is my new year so um I do treat it like a new year like a new season I try to hit the reset I literally start a new planner at that time I like to do my vision boarding and all the other practices that I do at the new year to kind of lay the groundwork for my New Year on this plane so when you get here let me know what your favorite holiday is today we are talking about steps to follow up on an insurance claim and I'm really excited to talk to you guys about this because so many folks have asked questions about AR follow-up so I'm going to move into the very specific topic of calls when you're getting on the insurance phone calls um we're not going to go too far in detail today today I'm going to talk a little further down the road of getting ready for those calls and what you um are going to expect and all that stuff so before I dive in um I just want to welcome you here if you're new here this is medical billers Network Live we are live every Thursday um somewhere between 6 and 6 30 Eastern time um and so if you are able to join live we're live on YouTube and our Facebook groups if you don't know what groups I'm talking about you can find the links in any of our videos and check us out on those platforms as well if you're here on YouTube make sure that you subscribe and make sure you do the notification Bell so that you know when we're live they'll also send you an email which is pretty fancy and I appreciate YouTube for doing that they'll send you an email to let you know that I'm live so you just don't miss it because we will have a conversation live and here on this platform I am back to Thursdays with you guys I'm very excited to be here and I want it to be a two-way conversation so if you are new to medical billing and or you um have you've been in medical billing and have lots to share with people who are new in medical billing please come and share your information share your knowledge this is meant to be a community where we can come together and share our knowledge for the sake the greater good of Health Care so for the sake of our patients right so all that we do with both of with this arm of my company and our billing company is for the sake of improving Health Care the delivery of Health Care by trying to eliminate all the messiness that happens on the business side of healthcare because the insurance companies like to make it a little messy for us so with that said um today we are talking about AR follow-up um when I say AR I mean accounts receivable so we're talking about insurance follow-up um on insurance excuse me follow-up on insurance claims so we typically affectionately call that AR follow-up if you have another name that you call it tell me what that is I'm curious I want to know you know like there's that a lot of things like there's a lot of changes in technology and other aspects of um of the world but Healthcare has been a slow move and trained so there's not a lot of new vernacular we'll say that's a fun word by the way vernacular there's not a lot of new words we'll say um in healthcare per se but you know I might be missing something so let me know if I'm missing something that you guys are calling it these days but um we've been OG calling it um AR follow-up or follow-up calls or ar calling or ar calls all means the same thing we are following up on insurance claims to find out the status of those claims or to find out what needs to happen I'm going to apologize in advance I'm getting a pop-up about internet I have no idea if that's impacting the connection I hope not if you guys get here and see that I've got a bad connection please let me know so I can be sad about it I'm just kidding I have no idea what I would do about about the bad connection honestly but uh wait until the connection gets better I guess um I don't know I am directly connected to ethernet so it might be um just the powers that be the internet Gods um controlling the speed today so I do know that um there's been lots of notifications about the storm coming in but I haven't seen anything about speed issues so please let me know if you get here and the speed is a little strange um ah yes I'm getting fuzzy interesting okay thank you for letting me know I don't know I don't know what else to do but let me know if it gets choppy and you can't hear my words I want to make sure that you guys can hear me loud and clear um please let me know in the comments somewhere yay awesome hi shea good it's good I sound good audio's good thank you sweet all right good deal well if you guys can hear me I'm gonna move forward we'll keep our conversation going the pop-up went away so hopefully that was just like a little glitch um but and we'll you know move this train but if it gets messed up again please let me know and we can maybe try to restart something all right so um first thing that we're we're chatting about the steps to AR follow-up or follow-up calls when we decide that we are going to start the process of follow-up Shay and ask your questions along the way by the way so as they come up or um you know as you as you um have questions about anything that I share um but as we know that you're going to start follow-up calls um the first thing you want to do is just have your stuff ready right so in the last live that we did um together we talked a little bit about what you really need to have to make those calls and and kind of like when you should make a call um and when you maybe should not make a call so um so what I want to make sure of is that you are prepared for those calls so the things that you might need to have are if you have like a physical report that you're working from have that ready um better off with your software if you can have your software accessible where you can um manipulate and look at charges you're going to need to have a lot of resource information or reference information I'm not going to run through those things again you can watch last week's live for those points I talked about the five W's in that video but you want to have your five W's ready so make sure you have all your information about your claim and whether that's in your software where you're referencing it or something that is on a physical report I would urge you if you are um accessing things remotely or you might have like a strange connection just do everything in your power to prevent yourself from not having access to the information while you were on the phone with the rep I say that from the perspective of like if you're logging into uh software remotely for example like um you're working from home and logging into a software if something freezes up and you've been sitting on hold for an hour nothing is more frustrating than to get to on the phone and be like oh no my system crashed or it's frozen or it's whatever so make sure you have it where you can reference it whether or not it's um the system is live if it's a system that you have access to right there on your local computer or perhaps you are accessing um a report or something you shouldn't have any problem with this so have that information available you might want to have a Clearinghouse available which is the processing tool that you're going to use for your claims that might be built into your software and I'll talk a little bit more in detail about that and how to use your Clearinghouse but for the sake of looking at what actually happened to the claim in route to the carrier and maybe even referencing um either a view of the claim data if it's not something that you can see so like if it's part of the actual um if it's possible for you to view a a viewable kind of pdf version of a claim in in your Clearinghouse that would help you so you see what data transmitted to the insurance company so that's really important to be able to kind of take a glance at what they got right so you are clear about it because sometimes what we see on the accounting side of the software is different than what we see in a Clearinghouse side so what you might have transmitted on your 837 claim file might be different than what was actually entered in or what appears on your accounting screen in your software you're also going to want want to make sure that you have any portals open from that carrier that might be providing helpful information and I say things like if you are calling about a previously processed claimed and you need to have your ICN number does anyone that's listening know what an ICN number is or an ICN I'll say does anyone know what an ICN is I'm going to leave that out there before I explain what it is so have your ICN if you need to reference your ICN um you you're going to want to have that insurance portal software open so no no all right so ICN number is an internal claim number that internal claim number is um is some people call it an insurance claim number it's an internal claim number but the insurance claim number the internal claim number from that insurance company is the claim the number that's been assigned to that particular claim when they received it so yes Shea awesome you got it yep so claim number so that's the number when they process your claim that they would have assigned to the claim and so let me turn this Banner off it's driving me anyway it's a little distracting from my eyes um so you're going to want to um to have that handy if you're calling about a previously processed claim so it's going to be a long um number to make sure that you you know have the ability to either copy that or write it down the portals time out typically meaning they might close out on you on like while you're on the call so make sure you have that somewhere else um I just I think that it's better for you to consolidate things and maybe even start a note into your software that says called Insurance to follow up on ICN number whatever and paste the number there so you're already starting on your note and you can reference that claim number for the rep that is um going to get on the phone so um step two so you have all your stuff open that's your step one so you've got your software your Clearinghouse your portal your report whatever you need to be able to start to do your research with someone on the phone keeping in mind that your um getting on the phone you need to understand why so step two is know why you're getting on the phone I'm getting a pop-up again guys I'm sorry I don't know what it is we're gonna blame it on the storm that's on its way here but I have no idea why I'm getting weird bad connection um it's like after hours and the building is pretty much empty here so it shouldn't be happening sorry about that um but basically what I was going to say is that um no number two know why you're calling so before you sit down to make a follow-up call know the reasons why you're calling and here are some of the reasons why you might call I'm going to go through these today this will be the focus of what we're going to chat about today so that you can really start to wrap your head around the reasons for a um for an insurance call and why it's something that you wouldn't always need to do okay so first thing is if an insurance claim was billed and you have not gotten an EOB or any sort of Correspondence or an update back from whether it's a claim rejection or anything back so claim build accepted by insurance no response okay claim build accepted by insurance no response that is a very basic claim request if you are calling for that claim request I should only see that happening in really one or two instances so one instance would be this particular insurance company is small that it does not have a portal at all so no insurance portal at all or your portal is down Insurance portal is down so you can't get on because it's down those that's the only two reasons why you should be calling for status if you're calling for any other anything other than those two reasons you're I mean for for a build claim with no response if you're doing that first you're wasting your time um you need to log into your claim portal your payer inch portal which is going to be the payer website right to to research the status of the claim first um and see what the status of your insurance claim is online because it's going to save you time it's a matter of punching a few Keys versus going through a lot of complicated interactive voice response systems to maybe get to a deadline or to get to a rep um and hold for rep all of that for you to just find out that the claim was paid on X date or whatever right when you can pull all of that information up on a website so super important that you start with no first why you're calling and if you are calling for a build claim without any response then only call for that type of claim if you don't have a portal access for whatever reason or there is no access because it's down it's just not working okay so that's one of the reasons why you might be calling the other reason why you might be calling is because you've got a denial from the insurance company or a claim rejection that you don't understand it's like claim is denied you have no idea why it's denied and you're looking at this denial reason and it's somewhat confusing you might assume this or that but you need clarification so that is reason number two that you might be calling an example of that is like a co226 that is a contractual obligation 226. we'll talk a little bit about what I'm throwing out there but that is an antsy code for a claim denial and that basically is saying that the billing provider or rendering provider is providing information that is insufficient that is the definition they give so it says billing a rendering provider is giving information that is insufficient or incomplete which is such a broad statement and it means nothing to you unless you get them to expand on that because it could literally mean anything on the claim or perhaps anything that was attached or not attached to the claim it could also mean in some instances an authorization that wasn't on file that they are using the wrong code or the system just uses this code to clarify or to communicate there's no authorization so this code co226 is an example of a of a code that is utilized in a denial on a denial that is very vague and it is not specific enough so if you are not sure what that is you might be calling for that there are instances that you might learn that this insurance company uses this denial code but they really mean this when they send it when you learn those kinds of Trends write them down on a referenceable document for yourself so you know ex-insurance company uses xcode but they really mean this so you don't have to call every time right so start to learn those types of Trends really important so number three reason why you might be calling is claim got process and it's either overpaid or underpaid and you're not sure what the heck they did with the claim now I say that you might be calling for that reason because actually a lot of portals have the ability to submit a request about an overpayment or an underpayment so again back to my don't waste your time calling the insurance when you don't have to when you can send a request on the portal because if you if you listen to last week's live you heard me share that when you talk to an insurance representative you are talking to that a representative of the insurance it's just a customer service person who is reading a updates from a computer okay they are not themselves the adjuster and they typically do not have any specialized knowledge except what was trained or what is available to them in their reference material right so they get taught just like any customer service rep writer at a credit card company or a store or whatever they get taught here are the potential types of calls that might come in and here are the things that you could help them with and here's the screens that you read from those types of things right they're learning situational um Solutions right so they really are not very specialized in helping you navigate the problems with your claims so if you can send a request through a portal that's going to get directly to a claims adjuster or to a software potentially that's going to review your request and apply some logic to the review versus you talking to a representative that's just typing your request for you is really what's happening so we talked about that last week at length but just know overpayment and underpayment might be a reason for your call but I don't necessarily think that you have to call unless your portal doesn't have the ability so I am you guys will learn that I am not completely against calling but I'm pretty far against calling I like to split up AR into like two levels level one is like everything that you can do before you pick up the phone and I'd say about 85 percent of what we do on this side of billing can happen without you picking up the phone about 15 is going to be done with a phone call okay so you'll hear this from me a lot I'm going to constantly be drilling this into you guys so that we are all on the same page of how we can optimize um and you guys who are Villiers I want to hear from you tell me what you've got going on if there's um there's anything on your mind um about what I'm saying today all right so um scenario number four is you are needing to get um clarification on something related to appeals so whether or not you need to have clarification on what how to submit an appeal properly what's needed to appeal something or you're looking for status of your appeal so those really things related to things you either are going to appeal or have already appealed so if you've already submitted an appeal and you needed the status or you need to know how to submit the appeal I will urge you to also check the payer websites for those rules and steps for appeals typically they have them outlined very clearly but if they you are not able to source that or you don't see that they have um that information available to you then certainly pick up the phone and just get clarification on whether or not you have the ability to submit an appeal in a more efficient way right and do they need documents there are some carriers that like you absolutely have to send and at this particular form attachment to your appeal otherwise they don't process that sucker so you're going to get your letter you're going to spend all that time making the perfect appeal letter and attach all your documents and all this stuff and pay twenty dollars to mail I'm just joking but pay a bunch of money to mail an appeal or whatever because it's expensive to mail and then the insurance company is going to kick it out and say no thank you because you need to send this form first so keep that in mind if you guys are are seeing um I forgot my train of thought I just went poof out of my brain out of my brain completely um what I was going to say was that if you find that the appeals process needs to um needs to to take place with some attachments you might be able to clarify that with a rep that's kind of where I was going but the exact words it disappeared from my brain all right so you've got all your steps those are the four the four things related to know why you're calling so that was all kind of related to your step two so that's like a little sub step so know why you're calling had the the different points related to build you know whether or not you are calling about a claim that was billed with no response or you got a confusing denial or you finding out about an overpayment or underpayment or looking about appeals okay the next thing that you're going to want to do before you are actually getting on the horn with someone is double check like what was the denial follow I'm always you guys are hearing me say this I'm going to constantly be saying it follow the breadcrumbs trace it back look and see okay what was the denial when was the last determination for this claim like maybe you resubmitted it as a corrected claim or whatever what is the last processing so you're not looking at the original one find out the last one here's a really important thing billers if you have multiple people working in your department look at the notes even if you are the last person who touched this claim maybe you gave some really great information about the status of the claim already that you can read before you get on the phone okay read the notes nothing drives me crazier than when I'm like going to an account and I see someone called on a claim and I look at the note from LA and they called in the same claim and it's exactly the same status update like I don't why why would you do that to yourselves like just read the documentation like someone's taking their time or you took your time to document and then you do the same thing again it's like you know what's the definition of insanity guys so let's make sure that you don't bypass the notes and actually read the documentation all right the very last step here for our follow-up process today getting started for this follow-up process getting started on your AR calling is be ready don't be distracted be ready to listen and to document properly I love that you all are like you know multitaskers and able to do a bunch of things but my friends who are working in a practice while doing billing you cannot have 10 patients in your waiting room and you're directing patients and checking someone out and you've got an insurance company on the line time while you're trying to pay attention to what's happening on that call it's a waste of time it might make you look really busy but it's a waste of time and it's a waste of energy so do these calls when you have the focus time and attention to give to them okay don't be trying to do 20 things at once all right just do one thing at a time with what AR calls focus on the the AR the actual now I'm going to say this I'm not going to say focus on the calls and only do the call listen when you're on hold you better be doing something else there's nothing like you're just sitting on hold but I mean when you're when you are actually talking to the representative and you get on the phone with them be ready to just talk to them have the conversation listen to what they're saying so you can ask the right questions don't waste their time or your time and then document what you hear so that you know what needs to take place all right so keep that in mind as you're moving through this the the next steps because it's going to be a huge waste of everyone's time and energy if you're sitting there having this halfway conversation and that you need to call back again especially if you've been waiting on waiting on hold and most of us with insurance companies these days are waiting on hold at least 20 minutes if you're getting less I'm I'm envious we have at least 20 minutes hold time so um and then um I'm gonna add one last little step that I realized I did not put in my notes um which is related to call on multiple claims at once most insurance companies have a limit of how many they're going to allow you to go over but I would suggest that you have at least four to maybe five claims that you're looking to research with that same company right so if you're calling Aetna I think they allow four if my billers are in the space y'all can correct me but I believe it's still four claims that they allow you to go over it can be from the same patient or it can be from multiple patients some insurance companies have tighter rules around that so if you are calling um an insurance company and you have a big old AR report that you're working on or a long list of um of patients that are outstanding for that insurance have at least four or five before you pick up the phone and before our five that don't fall into all of the other categories that I talked about right so if it's something that you can check on the portal all of the other status types that you can do in the portal do not just waste your time or the representative's time getting on the phone by you know just calling and not checking on the portal or even checking on the ivr because the ivr is available as well ivr let me just Define this again as the interactive voice response system that is the computer that you're talking to when you first call the insurance company we'll talk a little bit more about that in detail during next week's live um and today we are going to wrap this party up I want to know whether you found that helpful if you are new in this space of medical billing I you guys I say this every time and I continue to stress if you are building you you guys are like you're the gems you are the magic makers you have the keys to the kingdom most people don't understand what you are doing and so let's help the people that are new because most of us learn this just by doing it and after years and years of doing it like can we make it a little easier for the next generation of billers and it's it's not for only their sakes it's more for the long game effects right it's the for the sake of the patience for the sake of the providers for the mental sanity of all the people in healthcare like I don't know that many people in healthcare that that have like their sanity like that don't feel like they get to the point where they're like exhausted or drained or burnt out so let's change that even on the billing side like people leave Billing at some point typically because they get burnt out because of all the complexity and some of this is because like they've gone through all the pain and the anguish of learning this stuff this stuff that we hold so dear that we have the answers to so share our knowledge let's make it better let's make it better together um you are new here we're here every Thursday again between 6 and 6 30 and um yeah you guys I'm really excited about um keeping up with this conversation and on on live so yay thank you yes newbies need the help thank you Jenny for your comment newbies need the help in insurance companies don't tell you anything it's true there is I don't care how much training you get I'm going to be totally Frank you know you guys of those of us who are certified know this we learn a lot about the general concept of insurance and insurance world we don't learn enough about the nitty-gritty and how to get it done so this is the stuff that we learn on the job most of us so Lena thank you so much for your feedback your videos helped me so much with the new job that God I've never worked in medical billing before you're so welcome I'm so happy they help you I am excited you guys that I've been making more time to do these things um well I'm not going to just say making more time it's um it's also the gift of my team that's amazing that's been giving me more time and I've been using that time to give to this community and so I'm excited to be back at a normal a normal Pace if you are not already in the Facebook group um and you're a part of the medical billing Community you have to be a part of the community um at either interested in getting into medical billing or already in medical billing it's meant to be a community of billers or aspiring billers so if you are not already in that Facebook group then definitely check out the links um in the video so you can join it you have to fill out the questions you've got to fill out all the questions if you don't I gotta I have to reject you because it's really important to me that everyone acknowledges the rules I want to keep it very um very respectful if you were in other groups you will learn that some of them are not very nice and I'm just not that person if you've been here long enough you know that you know I'm a pretty nice person I think and I don't like people who are not nice so we will not invite them into our group if we find that they don't want to follow those rules to be kind to others so all right my friends listen have a great rest of this week and everyone who's in the path of the storm stay safe stay with your family your loved ones and um and just enjoy some hopefully some quiet time make sure you get your phones charged up and all the water and things that you might need all right guys take care of yourselves we will see you next week bye