When you realize that a claim hasn't been paid should you just resubmit it and hope it gets paid the second time? Even though 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 you show that it hasn't been paid.
One reason it is not a good idea to simply resubmit the claim is because Medicare and some commercial insurance carriers consider duplicate billings to be a sign of abuse and it can trigger an investigation for fraud. Also, if you resubmit a Medicare claim and the claim is for charges that are already in process it can cause a delay in the payment.
There are many reasons that a claim may not have come back paid other than that the claim was not received. The claim may have been denied, it may be pended for information, or it may have incorrect information on it which prevented it from making it to the insurance carrier. If you submit your claims electronically and there is missing or incorrect information, the claim gets rejected at the clearing house level and never even makes it to the insurance carrier.
A lot of medical offices do not have the staff necessary to do a complete job on the billing. The area that they end up letting slide is the follow up. Follow up is crucial to an office if they want to maximize their receivables but many offices do not recognize the importance, or just simply do not have the time. In most cases, the providers have no idea how much money they are throwing out the window by not having the follow up done regularly.
I was called into a very busy, 3 physician medical office where the office manager did not have time to do any followup. To make a long story short, I found over a half a million dollars in billings that were over 90 days old, but that's a different article!
Bottom line, it is not wise to just resubmit any claims that you do not show paid. If you are submitting claims electronically then you need to make sure you are taking care of the electronic reports showing the rejections. And you need to be calling on unpaid claims to make sure they were not received before you send them in for a second time. You don't want to be flagged as a billing abuser, or be investigated for fraud simply because you don't have the time to do proper follow up.
Source by Michele Redmond
