Monitoring claims should be a continuous process. Not checking aging reports for ignored insurance claims and leaving denied claims unresolved are practices that can leave a severe sum of money behind. We all know that the financial stability of any healthcare provider is maintained by having positive cash flow; this is where the A/R follow-ups serve its purpose. At Physician Revenue Solutions near Chicago, our goal is to ensure that healthcare practices run smoothly with fast and effective services that maximize financial return in the shortest period possible.
The Three Stages of an Accounts Receivable Follow-Up
Our team performs A/R follow-up work in three stages:
Stage 1: Initial Evaluation of Claims
During this phase, our team will identify and analyze all claims listed on the A/R aging report. They will evaluate the provider’s adjustment policy from which they’ll classify the claims that will require to be adjusted off. We can identify additional claims once we perform the analysis of timely filing limits.
Stage 2: Analysis and Prioritization of Claims
Our experienced A/R analysts execute this second phase by identifying claims that are marked uncollectible. We then look for outstanding claims where the insurance carrier has not paid according to its contracted rate with providers. The team will also ensure that “clean claims” will be reimbursed per the contracted fee schedule. We also monitor the filing/appeal limits of the major insurance carriers. Also, we review the “claims submission address,” so the claims reach the appropriate processing unit.
Stage 3: Collection of Claims
Claims within the appealing/filing limit of the insurance carrier get refiled. We ensure the accuracy of all necessary billing information (e.g., claims processing addresses and conformation to other medical billing rules). Should some claims exceed the filing limit of the insurance carrier, including apparently underpaid claims by the carrier, these will be appealed with the appropriate supporting documents.
Generally, appeal processes will depend on the specific plan, state, and insurance carrier. Procedures are applied and collected on claims that are being appealed. PRS ensures claims are smoothly and efficiently processed by electronically transmitting directly to the insurance carriers promptly. As for other carriers, we forward claims through clearing houses while the team aggressively follows up with the insurance carrier for information. To learn more about the medical clearing house, visit hhs.gov
With the completion of all the steps mentioned above, including the posting of payment details to the outstanding claims, patient bills are generated based on the client’s guidelines to be followed up with the patients for payments.
Benefits of Accounts Receivable Follow-Ups
The A/R follow-up team will be in constant communication with healthcare service providers, insurance firms, and patients. They will take the necessary steps based on their feedback. They are also responsible for reviewing denied claims, unfinished payments, correcting coding errors, and ensuring that all claims are followed through until the end. Therefore, the team’s skills and experience play a significant role in any healthcare practice’s financial health. Specifically, these are some of the reasons why A/R follow-up is a crucial element in the medical billing process:
Helps the Medical Practice Recover Overdue Payments
A/R follow-ups assist hospitals, physicians, nursing homes, and other healthcare providing facilities in recovering the overdue payments without a hassle. An efficient team ensures the on-time receiving of payments.
Ensures That the Insurance Claim Was Received
A claim not being received is one of the primary reasons why there are delays in payments. Claims go unreceived when paper claims are lost or misplaced before being delivered to the insurance firm. Rely on a workflow system that improves documentation quality to avoid losing track of claims. Specifically, automating workflow through the use of electronic files will allow for a more efficient process. If the claim has yet to be received, electronic forms will make it easier to send another request for the claim. Most processes will keep payments in the A/R system for a month or more. However, our team understands the need to have these payments processed and turned over to promote a smooth process of receiving payment. Our A/R process will ensure payments are out of the system in less than 20 days and post within 24 hours of payment receipt.
Minimizes the Time Within the Revenue Cycle
The A/R follow-up team’s primary goal is to minimize the amount of time that accounts are permitted to remain outstanding. The team will monitor accounts that have pending payments and determine the best suitable action required to secure payment. They will then proceed in implementing the necessary procedures to achieve payment successfully.
Why Having a Dedicated A/R Follow-Up Team For Medical Billing
Having a team devoted to A/R follow-ups will substantially reduce and eliminate the outstanding A/R. Also, A/R follow-up teams aid in collecting as much money as possible in the least amount of time. The large volume of outstanding claims, the process of researching, correcting, appealing, or refiling claims will consume much time. Therefore, having a team that’s focused on these tasks will help ensure a quicker, more efficient process. Specifically, a dedicated A/R follow-up team will have the following responsibilities:
- Look Over and Reopen Denied Insurance Claims – There are situations wherein the insurance carrier will deny claims if the claim doesn’t follow the rules. Therefore, it is essential to have a dedicated A/R team who can conduct follow-up procedures with the insurance carrier to resolve denied claims. The A/R team will look after denied claims and reopen them to secure full reimbursements from insurance companies.
- Provide Medical Billing Expertise – Medical billing and revenue cycle management handled in-house has become a thing of the past. With the evolving requirements and the need to be on top of these changes, healthcare service providers will need professionals with experience and a specialized skill set to perform essential procedures such as A/R follow-ups. At Physician Revenue Solutions, our revenue cycle management systems and practice management services help healthcare providers increase their profitability and manage their business. We employ skilled and well-trained individuals who have years of experience in the medical billing process and are experts at coding, ensuring success in the reopening of claims.
Schedule a Consultation With an Accounts Receivable Follow-Up Specialist in the Chicago Area
We understand that the follow-up process is critical to your business and gives you a healthier financial position, allowing you to focus on your patients. At Physician Revenue Solutions, our goal is to provide exceptional service that will enable you to maintain your practice and financial independence. Our processes have a track record of commercial success. To learn more about our services, contact our Buffalo Grove office today.