How to Reduce Outstanding Medical Claims
Outstanding medical claims can create additional administrative work and make it harder for practices to maintain visibility over their accounts receivable.
A consistent billing and follow-up process can help practices identify unresolved claims and determine what action is needed.
1. Monitor Claims After Submission
Submitting a claim is only one part of the billing process.
Practices should have a process for monitoring claim status and identifying claims that have not been paid or resolved.
2. Review Aging A/R Regularly
Regular A/R reviews can help identify accounts that are becoming older.
Pay particular attention to claims that have remained unresolved for an extended period and determine why they are still outstanding.
3. Investigate Denials
When a claim is denied, review the payer’s reason rather than simply resubmitting the same claim.
Determine whether the claim requires correction, additional information, resubmission, or an appeal.
4. Follow Up With Payers
Consistent payer follow-up helps practices determine the current status of unresolved claims.
Documenting follow-up activity can also help the billing team understand what has already been done and what action should happen next.
5. Review EOBs and ERAs
EOB and ERA information can provide important details about payments, adjustments, denials, and patient responsibility.
Reviewing these documents carefully can help billing teams identify unresolved balances and determine appropriate follow-up.
6. Track Recurring Problems
If similar claims are repeatedly denied or delayed, look for patterns.
Recurring problems may indicate an issue with:
- Claim information
- Coding
- Documentation
- Eligibility
- Payer requirements
- Internal billing workflows
7. Establish a Consistent Follow-Up Process
A defined process makes it easier to determine:
- Which claims need attention
- Who is responsible for follow-up
- When claims should be reviewed
- What action has already been taken
- What the next step should be
Final Thoughts
Reducing outstanding claims requires ongoing attention rather than a one-time cleanup.
By monitoring A/R, reviewing denials, checking claim status, and following up with payers, practices can maintain better visibility over unresolved accounts.
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