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A/R Follow-up and Aging Analysis

One of the major receivables for any practice comprises of unpaid claims of the services which have been provided in the past but have not been paid because of error in billing, wrong code selection or problem related enrollment and credentialing. Once you sign up for this service with Medstates, will work on receivables balance after doing detailed aging analysis and work on them based on their relative importance. Our team has expertise of accounts receivable and with team collaboration we will reduce receivable balance to as low as possible and will result in revenue optimization of your practice. Here’s a step-by-step guide to the accounts receivable process that MedStates perform to manage your accounts receivable (A/R) in medical billing:

Billing and Claims Submission

  • Ensure accurate and timely submission of claims to insurance companies. Proper coding, documentation, and adherence to billing guidelines are essential at this stage.

Claim Adjudication

  • Monitor the status of submitted claims to track their progress through the adjudication process. This involves verification, processing, and determination of claim payment or denial by the insurance company.

Denial Management

  • Address and resolve claim denials promptly. This may involve identifying the reasons for denial, appealing when necessary, and making corrections to resubmit claims.

Electronic Remittance Advice (ERA) Review

  • Regularly review electronic remittance advice from insurance companies to reconcile payments, identify underpayments, and address any discrepancies.

Payment Posting

  • Accurately post payments received from insurance companies and patients to the corresponding accounts in the billing system. This includes both electronic and paper-based payments.

Aging Report Analysis

  • Generate and analyze aging reports regularly to identify overdue accounts. Aging reports categorize outstanding balances by the length of time they have been unpaid.

Follow-Up Calls/Correspondence

  • Initiate follow-up calls or correspondence with insurance companies to inquire about the status of pending claims, verify payment details, and address any outstanding issues.

Patient Statements

  • Send regular statements to patients for outstanding balances. Clearly communicate the amount due, payment options, and contact information for billing inquiries.

Payment Plans and Financial Assistance

  • Work with patients to establish payment plans for outstanding balances. Offer financial assistance options when applicable, considering the patient’s financial situation.

Appeals and Resubmissions

  • If claims are denied, initiate appeals as necessary. Make corrections and resubmit claims promptly to maximize the chances of reimbursement.

Documentation

  • Maintain thorough documentation of all communications, follow-up actions, and payment transactions. This documentation is valuable for tracking the history of each account and resolving disputes.

Escalation

  • Escalate unresolved issues to higher levels within the organization or involve management when necessary. This may include complex claim issues, payment disputes, or persistent non-payment.

Analysis and Process Improvement

  • Regularly analyze AR performance metrics and identify trends. Use this information to implement process improvements, enhance staff training, and address recurring issues.

 

By following these steps, healthcare providers can streamline their accounts receivable follow-up process, reduce outstanding balances, and optimize their revenue cycle management. Regular monitoring, effective communication, and a proactive approach to resolving outstanding accounts are key to success in medical billing.

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FAQS

What are accounts receivable in medical billing?

Accounts receivable (A/R) in medical billing refers to the money owed to healthcare providers for services rendered. This includes outstanding payments from patients, insurance companies, and other third-party payers.

In the U.S., accounts receivable refers to any unpaid medical bills or claims that a healthcare provider or facility is waiting to be paid for services provided. These can be unpaid claims from insurance companies, patients, or both.

Accounts receivable billing involves the process of generating invoices for services rendered and tracking outstanding payments. It also includes efforts to follow up on overdue payments, verify claims, and resolve any discrepancies to ensure timely payment.

The three types of accounts receivable in healthcare are:

Patient Receivables: Payments owed by patients directly for services rendered.

Insurance Receivables: Payments owed by insurance companies for covered medical services.

Other Third-Party Receivables: Payments owed by other entities such as government programs or employers.

Follow-up is critical in medical billing as it ensures timely payment, reduces outstanding balances, and helps healthcare providers maintain healthy cash flow. Regular follow-up can also help identify and resolve issues with denied or delayed claims.

Aging analysis is the process of categorizing accounts receivable based on the length of time they have been outstanding. It helps healthcare providers identify overdue accounts and prioritize follow-up efforts to reduce financial loss.

MedStates performs a detailed aging analysis of your receivables, then works on each account based on its relative importance. This proactive approach includes claim tracking, denial management, follow-up calls, and documentation to ensure outstanding balances are minimized.

The process includes identifying the reasons for claim denials, appealing when necessary, making necessary corrections, and resubmitting claims promptly to maximize reimbursement. MedStates handles these processes to ensure minimal revenue loss for your practice.