Secure Billing Solutions number of services provided by physicians, hospitals, and nursing homes are continuously increasing. Each time patients are given treatment and care, they owe a certain amount to the physicians or hospitals.

An effective insurance model helps healthcare organizations in recovering over-due payments from insurance carriers easily and on time. This is when accounts receivable (A/R) follow-ups come into the picture. It helps the healthcare service providers run their practice smoothly and successfully, while ensuring the owed amount is refunded back in as short a time as possible.

Why is it Necessary to Have A/R Team for Healthcare Services?

The accounts receivable follow-up team in a healthcare organization is responsible for looking after denied claims and reopening them to receive maximum reimbursement from the insurance companies. Medical billing A/R and revenue cycle management handled by an in-house team is a thing of the past. Today, it demands billing professionals with a specialized skill-set to look after the A/R follow-ups.

It must be noted that along with A/R follow-ups, there are several other important processes such as charge entry, verification, and payment posting that need to be completed first. During these procedures a medical billing specialist determines the exact procedure code and diagnosis code based on the treatment plan. There are chances that the insurance company will deny claims if they don’t adhere to the rules, therefore it is crucial to have a dedicated A/R team who can follow-up with the insurance firm to resolve your denied claims.

The 3 Stages of Medical Billing A/R Follow-up

Most of the medical billing specialists perform the A/R follow-up in a very systematic manner, which is usually conducted in three stages:

Initial Evaluation

1

Analysis and Prioritizing

2

Collection

3

1. Stage 1: Initial EvaluationThis stage involves the identification and analysis of the claims listed on the A/R aging report. The team reviews the provider’s policy and identifies which claims need to be adjusted off.
2. Stage 2: Analysis and PrioritizingThis phase is initiated once the claims are identified which are marked as uncollectible or for claims where the carrier has not paid according to its contracted rate with the healthcare provider.
3. Stage 3: CollectionThe claims identified to be within the filing limit of the carrier are re-filed after verifying all the necessary billing information such as claims processing address and conformation to other medical billing rules. After completing the posting of payment details for outstanding claims, patient bills are generated as per the client guidelines and then followed up with the patients for payments.

Roles and Responsibilities of A/R Specialists

There is a massive amount of work to be done before the physician can claim an amount from the insurance firm. Ideally an A/R team comprises of two departments –

• A/R analytics
• A/R follow-up

The A/R analytics team is responsible for studying and analyzing denied claims as well as partial payments. Also, if any claim is found to have a coding error, the A/R team corrects it and resubmits the claim.

The A/R follow up team on the other hand constantly communicate with patients, healthcare service providers, and the insurance firms and take necessary actions based on their feedback or responses. The skills and quality of services delivered by the A/R team eventually helps in determining the financial health of a healthcare practice.