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 (A/R) follow-ups 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-ups.
It must be noted that along with A/R follow-ups, 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 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 conformation 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:
1. Financial Stability of the Hospital: The financial stability of any healthcare service provider is highly dependent on maintaining a positive cash flow. The hospital has to maintain a steady flow of revenue to cover expenses so as to provide patient care services, and the A/R department ensures this is taken care of.
2. Helps in Recovering Overdue Payments: A/R follow-up helps all hospitals, physicians, nursing homes, etc. to recover the 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.
3. Minimize Time for Outstanding Accounts: 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.
4. Claims Never Go Missing: 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 the 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.
5. Claims Denied can be Followed Up: Depending on the denial reason, you can actually send a new claim request with the required corrections made. 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.
6. Recover Claims Kept Pending for Information: 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 a suitable action is taken so that the process can be sped up.
Flatworld Solutions has been providing medical accounts receivable services for about 18 years now. Our highly experienced team of A/R specialists has worked with various insurance companies and is well-versed with all their policies. We ensure that our customers do not face any difficulties in receiving the payments for the services they have provided.
If you have any such requirement, feel free to get in touch with us or talk to one of our representatives and we will get back to you within 24 hours.
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