When you realize a claim hasn’t been paid, should you resubmit it and hope it’s paid the second time? Although in many cases an unpaid claim can mean that the insurance company never received the claim, it is not a good idea to simply resubmit a claim just because it shows that it has not been paid.
One reason it’s not a good idea to simply resubmit is because Medicare and some commercial insurance companies consider duplicate billing 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 it was not received. The claim may have been denied, hung up for information, or had incorrect information that prevented it from reaching the insurance company. If you submit your claims electronically and the 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 staff necessary to do a full job of billing. The one area they end up letting go of 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 just don’t have the time. In most cases, providers have no idea how much money they are throwing out the window by not having regular follow up.
I was called into a very busy 3 doctor medical office where the office manager had no time to do any follow up. To make a long story short, I found over half a million dollars worth of invoices that were older than 90 days, but that’s a different article!
Simply put, it is not advisable to resubmit any claim that does not show payment. If you file claims electronically, you need to make sure you’re dealing with electronic reports showing 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 the time to properly follow up.