Are denials and rejections spiraling out of your control? It looks like it’s time to revisit your AR recovery strategy for an efficient revenue cycle billing. An effective AR recovery strategy can lead to quicker payments and overall better financial performance. But, it’s essential to know how to start and from where to start? Healthcare practices lose a considerable amount of revenue due to denials and unpaid claims in revenue cycle billing. So, such missed revenue can be earned by reworking and appealing to the insurance payer. This process of following up on the denials with an insurance company until full reimbursement is called AR recovery.

The healthcare business is getting ever more complicated for professionals. With the rising deductibles and tighter payer reimbursements, this year promises to be even more challenging for providers working to take care of patients while improving their collections. Let’s take a deeper look at how AR recovery can help improve revenue cycle billing.

Aging Report of Account Receivable in Revenue Cycle Billing

  • Account receivable aging report usually helps classify denials based on the number of days for outstanding payments.
  • The longer the claims are in the aging group, the lesser the chances for reimbursements, which explains the need for AR recovery in revenue cycle billing.
  • An effective AR follow-up team and efficient denial management process can rework on denials and appeal for reimbursement with regular follow-up until the payment is collected and the claim is closed successfully.

Tracking and Analyzing your Medical Billing Reports

  • By monitoring all the claims to determine if the payment happened or was denied or delayed helps analyze collection percentage and helps pull out the claims to be followed up by the Accounts Receivable team.
  • Efficiency in revenue cycle billing is achieved when you establish an effective monthly reporting system that determines your practice’s revenue progression.

Metric-Driven Goals to Improve your Financial System

  • Every healthcare practice commits to its own goals and metrics that they need to achieve.
  • Financial goals act as key barometers to keep the revenue cycle billing process successful and progressive.
  • By concentrating only on increased patient visits, processing more claims monthly does not really increase your financial goals. The bottom line is achieved when a practice ensures maximum collections.
  • It’s also crucial to ensure every dollar that your healthcare practice has collected from the insurance company.

Having an Effective AR Follow up in your revenue cycle billing

  • Without a doubt, an effective AR follow-up can track all denied and low-paid claims and analyze based on the provider write-off and adjustment policy.
  • All the claims that have not been paid as per the contracted rate are identified and followed up based on the appeal and timely filing limit of the insurance company.

The Importance of EFTs and ERAs

  • First of all, Christina points out that practices “absolutely must look at Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) enrollments for all payers when possible.”
  • To start the above process, you can initially identify paper payments and remittances received and then determine if EFT and ERA enrollments are available.
  • Such processes expedite the delivery of payments and make it easier to reduce posting errors.
  • Most insurance companies do not allow EFT and ERA enrollments. So, you can focus on ERAs to see trending data of payments, underpayments, and denials.

Determine the root cause for Denials

  • An AR recovery strategy is to determine the root cause for the denials. While working with the insurance companies’ claim denials, it’s vital to identify payer trends and the root cause of denial trends and create action plans to prevent future related denials.
  • Christina also reveals the importance of understanding the payer’s CAS Codes.  When insurance companies use the same CAS Codes nationwide, not all the others use CAS Codes in the same way.
  • Due to the same reason, it’s essential to keep in mind that there could be a discrepancy between how the CAS Code is interpreted.
  • For instance, Blue Cross Blue Shield might use CAS Code 197 (authorization required) to deny claims not processed due to credentialing-related issues.
  • In contrast, many small insurance companies use CAS Code 197 as pre-certification or authorization or notification absent in its truest sense.
  • CAS Codes can be interpreted differently. Denials should not be worked solely by definition of the CAS Code.
  • Instead, try to review CAS Codes by payer group and link CAS Codes based on your knowledge of the specific insurance payer using them.

Claims with no response in revenue cycle billing

  • Claims with no proper response is one of the biggest challenges because those in charge of claim follow-up tend to think.
  • It sure will give you more time and makes you assume a response is just around the corner. It doesn’t stay the same forever. No response could possibly be the worst response you could receive.
  • By determining the duration of an insurance company typically takes to accept and then process a claim as well as state insurance processing and payment laws that can largely benefit your AR recovery strategy in revenue cycle billing.

Engage Patients When Necessary

  • One more account receivable strategy is to reach out to your patients when necessary and ASAP.
  • Patient outreach may include creating letters to your patients to request help in the claim resolution process.
  • The letter must cover the coordination of benefits, delays in the processing of payments by insurance, demographic-related information required from insurance, and why insurance is delaying or not processing the claims.
  • While reaching out to the patient, ask for help or information, let the patient know all of the efforts you have already taken to get their claim paid.
  • Sharing such information with the patients can build trust that you are doing your best to process it with the insurance company.
  • Patients are always typically eager to help when there are issues with the insurance company during the claims processing cycle.

Outsourcing can be the best and the only choice for an effective revenue cycle billing with a highly proficient AR follow-up team. They can handle AR recovery in a phase where the revenue cycle billing becomes more flexible and better.

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