The Avea Way: Best Practices for Billing Collections

Objective

As a billing collections specialist, your number one priority is to clear roadblocks claim by claim while also diligently labeling your claims in AveaOffice so managers and team leads can identify trends across payers, services, individuals, and teams which helps them address roadblocks for you.

Responsible

Members of the Billing Collection team check payer portals and complete payer phone calls.

Billing Managers make sure that the right people are working claims based on their skill and experience.

Divide the claim follow-up team into two tiers based on experience and types of calls. More complicated issues that arise during these calls should be escalated to the Tier 2 billers, who are more capable of troubleshooting claim problems over the phone.

Tier 1	Tier 2
Portal Checks	Prior Authorization discrepancies
Initial Claim Calls	Inconsistent reimbursement rates and pricing issues
Confirming status of additional inquiries or reviews	Payer system issues
Requesting EOB's or reimbursement data	Benefits misquotes
	Contracting discrepancies

 

Daily Process

• Payer Portal Checks

• Payer Phone Calls

• Note-Taking

• Update Claim Workflow

Step	Action	Tips & Notes
Set up your Work Center	Go to Work Center > Insurance Claim > Work Claims Filter to “Payer” Queue Expand assigned payers Open each patient in a new tab Sort by follow-up date	Sort by payer to make the most of your time on the phone since you may be able to address multiple claims in a single call for each payer. Keep in mind payer hours and prioritize calling payers that close earliest first. Use Assignments to narrow down who is responsible for certain claims/patients/payers. Create a template to quickly set the filters to the view you want to use.
Prep for the call	Review previous notes (if available) Check payer portal first (if available) If status is updated in the portal, skip to step “format notes”	Familiarize yourself with the claim before calling for claim status. Checking the payer portal first might save you a phone call altogether. See The Avea Way - Best Practices for Updating Claim Workflow
Call the payer	Give patient details to the automated message Get to a live rep to check claim status Set the stage for the live rep	Each type of call should have a “set the stage” guide which allows for the call to be expedient and goal-oriented ensuring consistency in the type of information everyone obtains for each item. See The Avea Way - Best Practices for Updating Claim Workflow for examples.
Note-taking	Take detailed notes using a template	Use a template for note-taking to expedite the process and make sure there is uniformity in claim notes across the team. See The Avea Way - Best Practices for Updating Claim Workflow for examples.
Repeat for as many claim status checks as the rep will allow
Update AveaOffice	Add Notes for each claim into AveaOffice Update Claim Status Update Claim Follow-Up Date	Use “Bulk Update” to edit all of these fields at once for multiple claims, if they all have the same outcome. Update your follow-up date for the next time you want to follow up on the claim. A good rule of thumb for setting follow-up dates is 20-30 days after claim submission, or 7-14 days after the last status check. Follow-up dates are automated when the claim is first submitted, resubmitted, rejected, and paid. See The Avea Way - Best Practices for Updating Claim Workflow
Identify Problems and Triage	Add Claim Issue (optional) Update Claim Queue (optional)	Updating claim issues and queues are critical to move claims forward in the adjudication process. Any claim older than 30 days outstanding should be tagged with a claim issue.
Move on to the next assigned payer to call

 

Weekly Process

Administrative Tasks

Step	Action
Set up your Work Center	Work Center > Insurance Claim > Work Claims Filter to “Administration” Queue Filter to “Open, Assigned to Me” Open a patient in a new tab Sort by follow-up date
Prep for the task	Review previous notes Assemble requested documentation Prepare to mail/fax/email to payer
Update AveaOffice	Add Notes for each claim into AveaOffice Update Claim Status Update Claim Follow-Up Date
Neutralize Triage	Edit/Remove Claim Issue Update Claim Queue
Move on to the next patient/task