AR & Denial Management is the main area to focus if practices want to successfully achieve their business goals. If a practice is having an effective accounts receivable and denial follow up strategy, only then the accounts balances show a positive outcome. If a practice lacks the expertise required to manage accounts receivable then it’s a sure way to lose a major portion of their revenues and sometimes without knowing about it. In a similar way, if medical billing resources are not following up denied claims with a clear strategy then they would fall through the cracks and would not be reimbursed anytime soon.
The accounts receivable aging is the most important thing to watch for, the sooner you get the returns the better you will find the financial health of your practice. Delayed collections and aging bills are more difficult to get reimbursed and each follow-up round would increase the operational burden and resource cost. Subsequently, by the end of a fiscal year, your practice can suffer huge losses due to piled up unpaid bills and it would become impossible to handle the burden.
The AR management has become more challenging in the recent years when practices are dealing with a rise in the payments owed by the patients. An increase in the number of patients on self-pay is making practices’ job more difficult they are required to realign their collections strategy. Practices should learn to handle the dilemma of high-deductible insurance plans. Dealing with a payer or an insurance carrier is totally a different scenario than following up the patients who are liable to pay back a major part of their medical bill. In such a situation, AR management becomes even more perplexed when practices are not ready to handle it and patients are unaware of their insurance plan.
So, what practices should do to keep their collections optimized with a perfect AR management strategy?
It is apparent that in such a situation where practices are required to handle multiple payers and everyone with a different process of payment then no single strategy can be fruitful. That is why more and more practices are outsourcing their billing to professional companies because they got specialized resources to handle all types of collections. They now very well the difference between patient AR management and insurance AR management. However, physicians should not segregate the billing from the front desk and other clinical processes. AR management is only effective if the front desk is working properly. It is not the billing company or the accountant that communicate with the patients for the payments, it is the job of the front desk to effectively communicate with the patients and deliver them very clearly about their financial liabilities. So, if you are experiencing a decline in collections despite being following an orderly AR plan, then you should check your front desk staff for the possible improvements.
During the last decade, healthcare has undergone a lot of transformation. Not only physicians and medical practices have changed to a different working style, processes and technologies, insurance companies have transformed as well. Insurance companies are devising new plans to compete a saturated market with insurance plans that can paint a desirable picture for buyers. They are offering insurance coverage with low premiums but higher deductibles. Doing so, they are adding up new requirements and regulations to make it difficult for claimers to get their payments. To ensure this, insurance companies are using sophisticated technologies that can easily detect a fault in the claims. So, the heightened requirements are resulting in the escalation of claims being denied. So, there is a need to implement a denial management strategy.
First of all, practices should devise a system to keep track of the denied claims. They should be using advanced practice management systems to enter all the claims that are denied with the reason. By entering this data, practices can easily take view of the percentage of denied claims with their dollar value.
In the next phase, practices should look for the major reasons for the denials. Most commonly, it can be due to an unauthorized service, wrong medical codes, mismatched patient information, missing documents or problem with physician credentialing.
In the last stage, make corrections and provide all that is required by the insurance company and resubmit the claim. These are just the basics of AR and Denial Management. The medical billing professionals of Sybrid MD are proficient in handling all types of claims, insurance companies and medical specialties. If your practice is experiencing claim denials and aging receivables, then stop worrying about it and reach us for a free consultation session.