The number of services provided by physicians, hospitals, and nursing homes are continuously increasing. Each time patients are given treatment and care, they owe a certain amount to the physicians or hospitals.
An effective insurance model helps healthcare organizations in recovering over-due payments from insurance carriers easily and on time. This is when accounts receivable (AR) Clean up services come into the picture. It helps the healthcare service providers run their practice smoothly and successfully, while ensuring the owed amount is refunded back in as short a time as possible.
The accounts receivable follow-up team in a healthcare organization is responsible for looking after 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-up services.
It must be noted that along with A/R cleanup services, there are several other important processes such as charge entry, verification, and payment posting that 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 and insurance follow up specialists who can follow-up with the insurance firm to resolve your denied claims.
Most of the medical billing specialists perform the A/R follow-up in a very systematic manner, which is usually conducted in three stages:
This stage involves the identification and analysis of the claims listed on the A/R aging report. The team reviews the provider’s policy and identifies which claims need to be adjusted off.
This phase is initiated once the claims are identified which are marked as uncollectible or for claims where the carrier has not paid according to its contracted rate with the healthcare provider.
The claims identified to be within the filing limit of the carrier are re-filed after verifying all the necessary billing information such as claims processing address and confirmation to other medical billing rules. After completing the posting of payment details for outstanding claims, patient bills are generated as per the client guidelines and then followed up with the patients for payments.
There is a massive amount of work to be done before the physician can claim an amount from the insurance firm. Ideally, an A/R team comprises of two departments –
The A/R analytics team is responsible for studying and analyzing denied claims as well as partial payments. Also, if any claim is found to have a coding error, the A/R team corrects it and resubmits the claim.
The A/R follow up team on the other hand constantly communicate with patients, healthcare service providers, and the insurance firms and take necessary actions based on their feedback or responses. The skills and quality of services delivered by the A/R team eventually helps in determining the financial health of a healthcare practice.
The major challenge most companies face in the medical billing process is A/R follow-up management. So why is it so important? Here are some of the more popular reasons:
The financial stability of every healthcare provider highly depends on maintaining a healthy cash flow. The hospitals and physicians need to maintain a secure flow of revenue to cover expenses and provide the needed patient care services effectively; the A/R department makes sure that all this is taken care of.
AR Cleanup services help all hospitals, physicians, nursing homes, etc. to recover over-due payments without any hassle. When there is a team which is constantly involved in the claims follow-up procedure, it becomes easier for the healthcare providers to receive payments on time.
The primary objective of A/R management is to minimize the amount of time that accounts are allowed to remain outstanding. The team tracks accounts that have not been paid, assesses a suitable action required to secure payment, and implements procedures for secure payment.
The biggest reason for delay in payments is due to the claim not being received. This usually happens when paper claims are lost. To avoid this, it is wise to send the claims in electronic form. If the claim has been followed-up and you are aware that the claim hasn’t been received, then it becomes easier to send another request for the claim soon.
Depending on the denial reason, you can actually send out a new claim request with all required corrections before you even receive the paper denial via mail. By contacting the insurance firm and enquiring why they denied your claim rather than waiting for your paper denial explaining the reason through the mail, the A/R team can make sure that all claims get corrected as fast as possible.
Sometimes claims are kept pending for a certain amount of time due to additional information needed for the member. By following up properly, the A/R team can inform the member about the situation and then suitable action is taken so that the process can be sped up.
Today, many medical providers find their medical practice growing in their monthly expenses but are not attaining the same progress in their re-occurring cash flow. Unless exact and regular active accounts receivable follow-up on the current billings is started, it is common to find a provider with excessive amounts in medical accounts receivable that are greater than 180 days outstanding.
Usually the volume of unpaid claims and the time it takes to research, correct, appeal, and re-file the claims will take much longer than estimated. A limited number of staff dedicated to this task will not be able to accomplish the goal, which is to extensively reduce/eliminate the outstanding accounts receivable and collect as much money as possible in a short period of time.
The medical accounts receivable program offered by eMedRCM overcomes the problems that basically delay the collection efforts by the individual providers. eMedRCM follows these accounts by assigning a full team of individuals. They are dedicated to resolve the unpaid claims in the minimum time possible. We utilize experienced, well-trained individuals in the medical billing process as our collectors. Most of these employees have years of experience in medical coding and collections.
Companies must have an efficient and smooth Order-to-Cash cycle to maximize their cash flows and collection operations. eMedRCM transforms end-to-end accounts receivable management by optimizing cash flows, lowering past-due receivables, and assisting in identifying revenue leakages and refilling gaps.
Our employees collaborate closely with insurance companies to manage collection activities effectively while maintaining client relationships. Our Accounts Receivable Solutions are comprehensive while being entirely adaptable, allowing clients to select the entire bouquet of services or begin a new assignment with a subset of processes, business units, or locations. In addition, we make sure that our customers do not face any issues in receiving the payments for their services.
eMedRCM provides the following accounts receivable services to hospitals, emergency rooms, urgent cares, and Clinics.
We do more than just billing – We transform the revenue cycle with solutions that streamline the patient experience, drive operational efficiency and improve financial performance.