When you realize a claim hasn’t been paid, should you resubmit it and expect it to be paid the second time? Although in many cases an unpaid claim may mean that the insurance company never received the claim, it is not a good idea to simply refile a claim just because it shows that it has not been paid.
One reason it’s not a good idea to simply refile is because Medicare and some commercial insurance companies view duplicate billing as a sign of abuse and can trigger a fraud investigation. Also, if you resubmit a Medicare claim and the claim is for charges that are already in process, it may cause a delay in payment.
There are many reasons why a claim may not have been paid, other than that it was not received. The claim may have been denied, you may have hung up for information, or you may have incorrect information that prevented it from reaching the insurance company. If you submit your claims electronically and information is missing or incorrect, the claim is rejected at the clearinghouse level and doesn’t even make it to the insurance company.
Many medical offices do not have the necessary staff to do a complete billing job. The area they end up missing out on is tracking. Tracking is crucial for an office if it wants to maximize its accounts receivable, but many offices don’t recognize the importance, or simply don’t have the time. In most cases, providers have no idea how much money they are throwing out the window by not following up regularly.
I was called into a very busy 3 doctor medical office where the office manager didn’t have time to do any follow up. To make a long story short, I found over half a million dollars worth of bills that were over 90 days old, but that’s a different article!
Simply put, it is not advisable to refile any claim that does not show paid. If you file claims electronically, you need to make sure you are dealing with the electronic reports that show the denials. And you should call unpaid claims to make sure they haven’t been received before you submit them a second time. You don’t want to be flagged as a billing abuser or investigated for fraud simply because you don’t have time to follow up properly.
