Remittance Processing Control Point continued
Most of these issues can be addressed through training and the application of appropriate resources. The general rule is to ensure everything received is posted timely. Any backlogs should be addressed immediately.
Third Party Follow-up Control Point
The third party follow-up control point is defined as the effort that is required to collect amounts due from third party payers after the initial claim has been filed. It can also be defined as direct management of third party receivables. This is often a human resource intensive process due to the complex guidelines and standards third party payers utilize to reject claims and reduce payments. It is certainly a mistake to expect payment
simply because a claim has been submitted. Many payers will reject claims, request additional information or simply not respond to claims for a variety of reasons. Their primary goal is to reduce their cash outflows by complicating the process for providers. This is successful because many providers are unable to properly respond to their requests in a timely manner. This effort by payers has increased over the years and thus efforts to counteract this game have been undertaken by the health care industry. For example, many
states have adopted prompt pay laws to protect providers and organizations have attempted to address denial management within managed care contracts. We will discuss each of these in a later module.
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