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

Always an effective insurance model helps healthcare organizations in recovering over-due payments from insurance/payer carriers easily and on time. This is when accounts receivable (AR) 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 period of time as possible.

Why it is Necessary to Have AR Team for Providers and Practices?

In a healthcare company, the accounts receivable follow-up team is in charge of monitoring denied claims and reopening them to ensure maximum recovery from the insurance companies. An internal team handling medical billing AR and revenue cycle management is a thing of the past. Today, handling the AR follow-ups requires billing experts with a unique skill set.

It must be remembered that in addition to AR follow-ups, there are a number of other critical procedures that must be finished first, including charge entry, verification, and payment posting. Medical Billing specialists chooses the precise procedure code and diagnostic code for these operations depending on the recommended course of treatment. If the claim doesn’t follow the guidelines, there is a potential that the insurance company will refuse the claim. For this reason, it is essential to have a specialized AR team that can follow-up with the insurance company to settle your disputed claims.

Billing Companies adopt 3 Stages of Account Receivable Follow-up

The majority of medical billing experts do the A/R follow-up in a very systematic manner, typically in three stages:

1. Identification of Claims
2. Analysis and Prioritizing
3. Collection

Let’s explore one by one.

Identification of Claims

At this stage claims identification and analysis is required on those claims are listed on the AR aging report. Experts of AR Follow up team reviews the provider’s policy, plans and identifies which claims need to be adjusted off.

Analysis and Prioritizing

At this stage 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 provider or practice.

Collection

After validating all relevant billing information, including the claims processing address and compliance with other medical billing regulations, claims that are found to be within the filing limit of the carrier are re-filed. Patient bills are prepared in accordance with client specifications when posting payment information for outstanding claims is complete, and patients are subsequently followed up with regarding payments.

Responsibilities and Roles of AR Specialists

Before the doctor can request money from the insurance company, there is a ton of work to be done. An AR team should ideally consist of two sections.

AR Analytics

The team in charge of AR analytics is in charge of researching and examining rejected claims and partial payments. Additionally, if a code problem is discovered in any claim, the AR team fixes it before resubmitting the claim.

AR Follow-up

The AR follow up team, on the other hand, keeps in continual contact with patients, healthcare professionals, and insurance companies and takes the appropriate action in response to their feedback or responses. A healthcare practice’s financial stability is ultimately determined by the abilities and quality of services provided by the AR Experts team.