AR management is an important part of the medical billing process and it’s a key of financial stability and success of a medical practice. Accounts receivable basically refers to the sum owed to the medical practice for services provided by physicians but not yet paid for. Then AR teams make strategies to receive maximum reimbursement from the insurance companies
The number of services provided by doctors, hospitals, and nursing homes are continuously increasing. Physicians give medical care and treatment for an illness or injury to patient, then patients have to owe a certain amount to the physicians or hospitals
The accounts receivable follow-up team in a healthcare organization is responsible for taking care of denied claims and reopening them to receive maximum reimbursement from the insurance companies. Medical billing A/R and revenue cycle management handled by an in-house team is a thing of the past. Today, it demands billing professionals with a specialized skill-set to look after the A/R follow-ups.
It must be noted that along with A/R follow-ups, there are several other important processes such as Charge Entry, insurance verification, and payment posting which need to be completed first. During these procedures, a medical billing specialist determines the exact procedure code and diagnosis code based on the treatment plan. There are chances that the insurance company will deny claims if they don’t adhere to the rules, therefore, it is crucial to have a dedicated A/R team who can follow-up with the insurance firm to resolve your denied claims.
Importance of A/R Follow up for RCM
There are some key points for A/R follow up in medical billing which are as follows:
- Claims Never Go Missing
- Denied Claims Can Be Followed Up
- Helps in Recovering Overdue Payment
- Improving Collections.
- Claim is Pending for Information from the Member.
Claims Never Go Missing
The major reason for delay in payments is due to the claim is not on file. It’s usually happens when paper claims are lost and don’t reach to the payer. To avoid this, it is wise to submit the claims electronically. If the claim is followed-up and you can track easily that the claim is not on file via call insurance companies and check on insurance web portal, then it becomes easier to send another request for the claim again.
Denied Claims Can Be Follow Up
Depending on the denial reason, you can actually send a new claim or corrected claim after fixing the denial. By calling the insurance companies and finding out the denial reason instead of waiting for the denial reason on mail, the A/R department can ensure that all claims are followed through till the end. There are some basic denials which are as follows:
- Inactive coverage
- Duplicate billing
- Diagnosis issues
- Missing authorization
- Submit the claim to incorrect payer
AR specialist can fix these denials easily and makes the practice smooth and more profitable.
Helps In Recovering Overdue Payment
A/R follow-up helps all hospitals, doctors, nursing homes, etc. to recover the over-due payments without any hurdle. When there is a team which is continuously involved in the claims follow-up procedure, it becomes easier for the healthcare providers to receive payments on time. The team tracks accounts that have not been paid, assesses a suitable action required to secure payment, and implements procedures for secure payment.
The longer the accounts go uncollected, the greater the loss of revenue and the greater the amount of resources that the practice would need to set aside for collection efforts. The key to resolving this issue is to include accounts receivable aging and days or months outstanding in a monthly key indicator financial report Then AR teams make strategies to receive maximum reimbursement from the insurance companies. Analyzing your practice`s collection policies against these survey results can pinpoint your deficiencies. Furthermore, implementing the recommended strategies will allow your practice to increase the percentage of collections received at the time of service and to collect any in-office billings on time for greater profitability
Claim is Pending for Information from the Member
Sometimes claims can be placed in pending for a certain amount of time due to additional information needed from the member. Although the insurer has probably sent the patient a letter in the mail, it would be wise for your collectors to contact him/her as well.
One reason is that by calling the insurance, you can notify the patient before the letter ever reaches them. Also, if you can get them on the phone, you can hold a conference call with the member and insurer to make sure the information is given and received.
If you need any assistance in AR management, Adnare can provide you unique AR management services to increase your RCM. Please Feel free to contact us for more details at 949 346 4414 or visit our website to discover more www.adnare.com .