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In addition to reviewing charge slips and tracking payments, medical billers also examine records to provide individualized reports that highlight profitable regions and point out areas that want improvement. Every report that evaluates "how well a medical practice functions" centers on account receivables. When choices need to be made about contract renewal and negotiation, such reports are essential. They also give physicians advice on new coding procedures, updated pricing structures, and strategies to boost the office's profitability.
Medical billing's final expert task is managing accounts receivable (AR); the sum of all departments' efforts is "how much is the collection for the month." One may evaluate the efficiency with which the billing department operates and the depth of their understanding of the revenue cycle by looking at the AR days and the related amounts in each day bucket. Unpaid claims, low payments, denials, and appeals place further pressure on billing teams and force the department to form a new team to handle AR again, which adds to the expense for hospitals and individual practices. Billers are burdened more because of the ever expanding insurance updates, patient plans, and payer reimbursement patterns.
When it comes to reimbursement, insurance companies frequently engage in the age-old game of "hide and seek," and many engage in "throw in their towels" behavior fairly quickly. a problem with the medical service Insurance firms benefit off of provider money. For billers, calling the insurance is a time-consuming task that takes up valuable time throughout the day. On average, it takes 10 minutes to speak with a live person about a claim. Therefore, the work cycle continues with a backlog of unanswered claims, appeals, and patient data that results in worrying AR days. MF can support your practice in the following ways: proactive AR calling, following up on pending claims, starting collections, examining the causes of denials, monitoring outstanding receivable balances by client and by the due date for payment, giving quarterly reports, and more.
Accounts Receivable, which is the total sum of money due to a practice for services given but not yet paid for, is an indicator of what's happening inside the practice's economic structure. A medical practice should evaluate its financial situation at least once a month, just like practically any other firm. This is the single most crucial step in handling an office's accounts receivable. It will reveal whether a practice is advancing or has reached a standstill if done consistently and on a regular basis. You won't just be able to tell whether there is a problem; in many cases, you will also notice some signals that enable you to identify circumstances and deal with them before they turn into difficulties. The most profitable practice can be destroyed by an uncontrolled, unmanaged A/R. A practice provides a patient with the necessary medical care and charges for it. The following presumptions are then made after the charge converts to an account receivable. The initial presumption is that the patient or a third party acting on their behalf will promptly pay the bill. Sadly, A/R involves 100 patients and charges rather than just one patient or one bill. An unmanaged A/R might lead to a situation where a busy, active practice does not have enough cash on hand to satisfy payroll or sufficient cash flow to support its needs.
The process followed at MF for Account receivables & follow up. This process is also relevant to denial management.
1. Run an aging report based on AR days, this is important step to understand how old are receivables pending since the claim submitted to insurance carrier.
2. Target the old AR days starting from 120days above and then come down the order of days. Older requires foremost attention first because closing window period for claim submitting/resubmitting and appeals is in danger.
3. Segregating the claims based on financial class and insurance carrier. This gives a better picture which insurance company claims are pending more and less.
4. Financial class: The financial class, or the type of financial arrangement under which the bill will ultimately be paid, can be used to categorize an A/R. Examples include Medicare, Medicaid, Commercial Insurance, Contractual Care, PIP, workers comp and Self-Pay. The financial classes that make up an A/R vary from practice to practice and can significantly impact how many accounts are outstanding, which is frequently substantially more than it is in other specialties. Some FC such PIP or workers comp AR would take much longer period for claim settlement since there could be litigation, attorney and third party dispute involved and even lead to arbitration.
5. Checking the patients eligibility and benefits sheet as some denial are pertain to patient benefits: No of visits limit, frequency, cap per day, $$benefits exhausted which requires provider write off.
6. Start working on the insurance carrier which very short window period on first priority.
7. Looking into the patient account and investigating the pending claim from below points
a. How much $ is pending on the patient case?
b. How many date of service is pending?
c. How many line items still not paid?
d. Is there payment note linking to open line item?
e. Any previous follow up phone call notes found?
f. Analyzing EOBs and patient documents.
g. Reviewing the benefit of the patient.
h. Summering the investigation and action planning
i. Making phone call to insurance company and fighting it out why the claim not paid; escalate phone calls to supervisor and resolve the claim for payment.
1. Sending claim back for reprocess
2. Appeals
3. Arbitration
j. Resubmitting claims: After a thorough analyzing the EOBs and notes including medical records (phone calls if required) correcting the claim (CPT/Modifier/units/POS/TOS) and then resubmitting the corrected claims.
k. Submitting medical records: Some payers require supporting medical records to substantiate medical necessary for reconsideration, COB, secondary EOB.
l. PIP carriers demand more supporting and validation records to process the claim if not they will deny/pending since there is a litigation, attorney or third party dispute.
1. Application of benefits
2. 21days notice medical treatment for some state
3. Affidavit of no insurance
4. Proof residency
5. HIPAA notice form
6. Assignment of benefits/signed authorization from patient
m. Again follow up with insurance after a set date.
Prominent billing software used in the US medical billing industry that MF billing and AR team familiar with and having hand on working experience.
By outsourcing AR to MF how you can be benefited:
Our account receivable follow-up and medical billing procedures are among the best in the industry. You are free to select the price model with MF that suitable for you, which can be based on hourly, cost per FTE/monthly. per unit claim of work completed, percentage of collection, etc. We may adjust the cost of our AR follow-up service to suit your particular specialty requirements.
We have TWO delivery hubs in Chennai TN, which enables us to offer prompt data entry management and accounts receivable follow-up services. These delivery centers work around the clock to provide you a time zone advantage and MF reassure you that our representative will always be available for calls throughout your working hours.
Your medical staff will no longer be burdened with the tedious long hold phone calls with insurance rep if you outsource the accounts receivable process to MF. By doing this, they will have more time to concentrate on their strengths and can give their patients greater treatment.
MF has been a trendsetter in the field of medical billing and coding, as well as accounts receivable follow-up services. With over 50plus years of combined experience in the healthcare services sector, we have enough expertise to meet the various needs of clients from all over the world. Some of the most knowledgeable professionals in US medical insurance who have worked with different specialties, hospital billing, and dental billing make up our team. We are able to provide top-notch services quickly and scalable because to our multiple delivery centers located in different locations.
Send us an inquiry if you're interested in outsourcing Account Receivables of your healthcare business to MF, and we'll respond with the best possible solution.
