Patient’s Insurance Aging Clean-Up

Insurance aging cleanup is a process of systematic updating of insurance information for a group of policyholders. The main attempt of doing this is to make sure that the sensitive patient information for each holder is updated, accurate, and in no conflict with the regulations of the insurance companies.

This usually involves a comprehensive review and verification of the insurance information for each policyholder, correcting any errors or inaccuracies, and updating the policyholder’s information as needed. This may include updates on the policy holder’s contact information, coverage amounts, policy expiration dates, and other relevant details.

The insurance aging cleanup process is important for a variety of reasons, including improving the accuracy of policyholder information, reducing the risk of policy lapses or cancellations, and ensuring that the policyholder’s insurance coverage remains in compliance with regulations. By ensuring that insurance information is up-to-date and accurate, insurance companies and other organizations can improve their operational efficiency, reduce costs, and enhance their overall customer satisfaction.

Insurance aging clean-up can have a significant impact on the revenue cycle management (RCM) of a healthcare organization, as it can help to ensure that insurance claims are processed correctly and paid in a timely manner. This, in turn, can positively affect the organization’s revenue.

A medical biller can perform a patient insurance aging clean-up by following these steps:

1. Review of the Patient Information.

The billing information verification begins with the updated contact information. Insurance and demographic information are also important since some coverage information can be indirectly affected by these changes.

2. Review of the Insurance Coverage:

This step can be done by using the online verification system or by calling the insurance company itself. Doing this will confirm the patient’s coverage amount, copays, deductibles, and any other relevant details.

3. Updating the Patient Information:

When the biller finds any of the information to be inaccurate or outdated, the biller should update the patient’s information in the billing system.

4. Reviewing the Claims History:

In order to have a smooth-running billing process, the biller should identify the reasons for previous claims denials or rejections and if these can be simply avoided by merely updating the patient’s information, then the medical biller may do so to prevent future delays in the patient’s claims.

5. Follow Up on Pending Claims:

Pending claims may take some time to be reimbursed and some may even be lost or stacked on by the payer’s side. The biller should follow up on any of these pending claims to maintain cash flow. Unpaid copayments, on the other hand, are collected by account receivable specialists and an updated database of the patient will make the collection process easier.

6. Insurance Aging Monitoring:

The biller should monitor the insurance aging of each patient’s claims. If a claim has aged beyond the typical payment timeline, the biller should take steps to resolve any issues and ensure that the claim is paid.

By following these steps, a medical biller can perform a patient insurance aging cleanup, which can help to improve the accuracy of patient information, ensure that claims are processed and paid correctly, and reduce the risk of denied or delayed claims.

Several challenges can arise when performing a patient insurance aging cleanup, including:

1. Inaccurate Information:

Probably one of the biggest challenges is the accuracy of patient information, as outdated or incorrect information can lead to denied claims and delays in payment.

2. Changing Insurance Coverage:

Another challenge is that patients’ insurance coverage can change frequently, which can make it difficult to keep up-to-date and accurate information on file.

3. Delays:

Insurance verification, updating patient information, and resubmitting denied claims can be time-consuming since they require investigative work and strong attention to detail. Some companies have a separate group of people who do this so as to let the medical billers and coders focus on their main tasks.

4. Manpower and Resources:

Technical issues can definitely affect the work of a medical biller. Offices with limited resources may find this a challenge even though skills-wise, the billers are capable.

5. Compliance Requirements:

Healthcare organizations must also be aware of and comply with regulations and guidelines regarding the handling and storage of patient information and insurance information. Knowledge of HIPAA should be always updated and even on the guidelines CMS and private insurance companies implement.

This may not be a problem anymore to some but in some cases, the data management systems used by healthcare organizations may not be efficient or sophisticated enough to handle the volume of patient information and insurance information. An outdated management system service may be prone to cyberhacking and information theft.

Despite these challenges, performing a patient insurance aging cleanup is important for improving the accuracy and efficiency of the revenue cycle management process, reducing the risk of denied claims, and enhancing patient satisfaction. Healthcare organizations can address these challenges by investing in robust data management systems, providing adequate resources and training for staff, and staying up-to-date on regulations and compliance requirements. Here are a few ways that insurance aging cleanup can impact the RCM:

In conclusion, insurance aging cleanup is an important aspect of RCM and can help healthcare organizations to improve their operational efficiency, reduce costs, and enhance their overall financial stability and patient satisfaction.

patient insurance aging clean up
Scroll to Top