Every medical practice desires to perform medical billing and coding much more efficiently and qualitatively, thereby improving their clean claims rate. But then, claim denials, claims rejection, and underpayments are inevitable. Most medical practices' revenue cycle is strained due to failing to work keenly on denials and ignoring the claims yet to be paid. There is an excellent chance to earn these missed revenues if they are reworked and appealed to the payer. AR recovery is the process wherein the denials are consistently followed-up until complete reimbursement with an insurance company. Effective AR follow-ups in medical billing assist in recovering the aging claims' payments.
Why are AR follow-ups in Medical billing important?
Based on the total number of days the payments are outstanding, the denials are classified with the help of an accounts receivable aging report. AR process plays a critical role in medical practices because; the prospect of reimbursement reduces if the claims are on the aging list for a long time.
It is crucial for the Denial Management and AR follow-up teams to ensure and effectively rework the denials and those appeals in the queue for reimbursement. They must consistently follow up in anticipation of collecting the payments so that the claim gets closed favorably.
Why do the Medical Billing Reports need to be tracked and analyzed?
If all the claims are continuously monitored, it is easier to determine whether the payment was received, if the claims got denied, or if the claim was underpayment. By doing so, you can quickly analyze the collection percentage and also dig out those claims; the Accounts Receivable team must follow up vigorously.
Creating an efficient monthly reporting system enhances the competence of Medical Billing. By doing so, you can also ascertain the progress of your practices' revenue.
How can you enhance your financial system with Metric-driven goals?
Achieving specific goals and metrics is essential for the medical practice as a business entity. Financial goals are indispensable to keep the business thriving and consistently to remain progressive. The real key to the medical procedure is when they ensure to increase their collections and not just focus on maximizing patient visits or enhancing the monthly claims processing rate. Only when every single due amount is collected from the insurance company, the medical practice can assuredly increase its collections.
Why is an effective AR Follow-up needed?
Based on the write-off and the adjustment policy of the provider, it is easy to track the entire denied and underpaid claims through an effective AR follow-up. Ascertaining the appeal and on-time filing limit of the payer, identifying and following up on the particular claim that has not been paid as per the rate of contract can be easily tracked.
Why EFTs and ERAs are essential?
Whenever possible, Electronic Fund Transfer (EFT) and Electronic Remittance Advice (ERA) enrollments must be considered by the Providers to benefit both them and the payers. To initiate this process, first, you must be able to identify the remittances and paper payments that have been received. You could then determine if these EFT and ERA enrollments are at your disposal. Posting errors get minimized, and delivery of payments gets sped up through these processes.
What are the challenges involved in this Account Receivable Process?
Seamless account receivable management is vital to identify the critical challenges while handling and working closely with insurance companies' claim denials. By doing so, you can easily create a plan of action to avoid such claims and denials in the future. A few of the challenges are mentioned below:
• Identifying the root cause for the claims denials
• Understanding the payers' CAS codes
• Claims with no response
• Determining the duration of an Insurance Company
Why is it necessary to reach out to the patients?
Patient outreach is one of the effective strategies in the Accounts Receivable Process. You can draft letters requesting help from the patient to offer their support in the claims resolution process. It is highly appreciated to ask for specific information during your patient outreach. The letter must be comprehensive and mention all the required details on the coordination of benefits, insurance side delays in the payments processing, and why it is getting delayed, along with the information related to their demography. By doing so, you reveal to the patient all the efforts you have been making to get them paid for the claim. When this kind of information is shared, it is easier for the patients to build trust, and they are eager to help in care if any issues arise with the insurance company during the claim processing cycle.