RCM is the most sensitive area for healthcare facilities that can’t be sidelined. In the healthcare industry, where providers are focused on delivering the best quality care to the patients, there is a problem that keeps piling up behind-the-scenes in the billing process. Even a small error in the medical billing world can slow down the flow of your payments. The scenario in which insurance companies don’t pay the medical claim on time, that particular claim becomes delinquent.
When the claim becomes delinquent, it not only affects your cash flow, but also leads to uncertainty in your administrative world. This results in a sense of burden and frustration for both staff and patients. And the worst part? The longer your claim stays unpaid, there are less chances for it to be ever collected in full and final.
As per the report of the Medical Group Management Association (MGMA), an average healthcare practice experiences a denial rate of 5% to 10%. And among that almost 65% of the medical claims don’t even get the chance to be resubmitted. It means that the huge chunk of revenue is just slipping through the cracks in your revenue cycle.
In this blog, we will understand what delinquent claims really are, how they impact the overall revenue flow, and what exactly needs to be done to prevent them.
Let’s begin!
What is a “Delinquent Medical Claim”?
Before we go deep into the prevention strategies, it is important to understand what a delinquent claim is.
A delinquent claim refers to the insurance claim that is not paid to the healthcare provider or professional within the timeframe it should have been paid. It depends. For most of the payers:
- Claims are expected to be paid within 30 days
- Paper claims usually get up to 45 days
These timelines are followed by most of the insurance providers, including Medicare and Medicaid. If deadlines are to be met, healthcare providers must take the steps accurately and within time. It begins from patient registration, then coding, to final claim submission of medical claims. And the entire process is so sensitive that if anything is missed at any step, your claim might not get paid on time.
When the insurance payer doesn’t send the payment within the expected window, the claim is said to be delinquent. This is the point where the healthcare provider or their in-house team should take action to fill the loopholes. It includes - reviewing the claim for missing modifiers, CPT/ICD-10 coding errors, getting confirmation whether the claim was received by the payer, initiating resubmission, if needed.
One important thing to note here is the fact that a delinquent claim is not the same as a denied claim. A delinquent claim can be on hold due to something like an incorrect address of the payer or any missing document.
Average Payer Response Times for Non-Delinquent Claims
Often payers are required to reply to non-delinquent medical claims within:
- Electronic claims (EDI) take 7–15 business days.
- Paper claims take 30 to 45 days.
Depending on state laws and the payer's internal procedures, these deadlines may change. For instance:
- Medicare: Usually takes 14 days to process clean claims.
- Medicaid: Depends on the state, it usually takes 30 days.
For clean electronic filings, commercial insurers typically reply between 15 to 30 days.
A claim enters the delinquent phase if it is not acknowledged or processed within specified windows, particularly if there is no payer communication.
The Real Cost of Delinquent Claims: More Than Just Cash
Out of all the damages the immediate loss of revenue is only one aspect of the effects of delinquent claims. More than that, it has an adverse impact on reputation, operational effectiveness, and even patient trust.
Disruptions in Cash Flow:
Payroll, equipment purchases, and service expansion are all hampered by unpaid claims, which postpone revenue collection.
Increase in Administrative Burden:
Time and resources are diverted from patient care by tracking denials, resolving patient confusion, and handling collections.
Damage of Reputation:
Unfavorable patient experiences brought on by unexpected invoices or collection attempts may lead to negative evaluations and a decline in patient loyalty.
How to Prevent Delinquent Claims in Your Healthcare Practice
As of now, it is clear that Delinquent Claims have the capacity to disrupt the entire entire revenue cycle management and other operations. When we improve the claims and save them from being delinquent, it can significantly improve financial stability and reduce administrative burdens for the healthcare facility.
Below are some techniques that will assist you to keep the Delinquent Claims at bay:
Keep an Eye on Payer Timeliness
It is crucial that you monitor the response times of payers. Make sure that you understand which payers are slower than others and modify your expectations appropriately.
Put an Effective Collections Strategy
Make Sure that have a clear and consistent collections strategy when claims do get past due. You must have explicit guidelines for managing past-due accounts, such as when to involve collections, when to send reminders, and how to handle patient complaints.
Trust the Experts for Handling Your Billing Process
You can lessen the administrative load and guarantee that claims are handled by experts who keep up with payer standards and industry developments by outsourcing your billing to a qualified team like Eminence RCM. This can fasten up the entire procedure, cut down on costs, and keep claims from going past due.
Ensure that Your Claims are Clean
If you want to avoid delaying claims, accuracy is not negotiable. Before you go for final submission, it is essential that you double-check the coding process, insurance eligibility, and patient data to prevent typical mistakes that can result in rejections.
Focus on the Process of Follow-Up
Create a habit for routinely following up on claims. Make sure you stay on top of pending claims and swiftly resubmit any refused claims. It can be done through automatic reminders or manual checks.
Keep Patients Informed of Their Obligations
To avoid any shocks later, be straightforward with patients about their financial obligations. When claims are transferred to them for settlement, clear communication is the key to minimizing chaos and ensuring clarity.
Without any doubt, there is always a serious need for a trusted medical billing partner such as Eminence RCM if you want your claim submission process to go smoothly and avoid Delinquent Claims on the way. This is surely the frontline defense against revenue loss as you focus on your patients.
When experienced billers and coders have your back, you don’t have to think about how your claim submission process is going on. You can be rest assured that your claims are clean, submitted on a timely basis, and promptly resubmitted in case of any denials.
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