What defines outstanding claims?

Outstanding claims are defined as those claims that have not been paid properly and require follow-up. This status indicates that there is an issue with the claim's payment, whether it was denied, underpaid, or is still pending review. In the billing process, it is crucial to track these claims to ensure that they are addressed promptly so the practice can receive the revenue owed for services rendered.

Focusing on claims requiring follow-up is essential in maintaining the financial health of a practice. Proper management of outstanding claims allows for effective cash flow and minimizes the time between service delivery and payment. For a billing office, monitoring these claims ensures that they are actively pursued and any necessary action taken, such as appealing denials or correcting billing errors.

Claims that have been fully paid, those under review, or claims with no errors detected do not fit the definition of outstanding claims, as these statuses indicate that the claims have already been resolved in some manner or are in progress but not requiring immediate follow-up for payment issues. Understanding the distinction is important for professionals working in billing to prioritize their efforts appropriately.