Reducing the AR days and improving the health care collections

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Published: 21st March 2011
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The money that is pending from the insurance companies as receivables and the AR days will define the performance of the medical billing company or the providerís office that is collecting the receivables. Thatís why AR analysis is considered as one of the key sectors of medical billing.

AR analysts play a major role in transforming the denied claims in to payments. Analyzing the under lying issues will help the AR analysts in controlling the AR days in certain cases while there are several reasons for the delay/denial in payment of the claims.

* Claim denial occurring due to patientís non-eligibility of the insurance

* Delays due to adjudication issues

* Pending for request of clarification or documents

* Denials due to errors in coding, charge entry etc.,

* Delay in payment due to insufficient funds with government aided insurance carriers

* Filing of the claims beyond the claims filing limit

Factors that will enhance AR operations:

* The clarity in process and systematic follow up with the insurance carrier for paper as well as electronic claims will boost the payment.

* Perfect knowledge about the insurance companiesí policies and procedures will help the AR analysts in handling the claims easily

* Referring the document management system for any clarifications can solve major issues. At times, this can solve the global issues, solving at a time, hundreds of issues in a single corrective measure.

* Maintaining the logs that will contain the solution for similar issues will help the AR analysts in deciding the next action to be taken on denied claims.

* Maintaining good rapport with the insurance company will help the physiciansí office or the physician billing company in solving the issues more effectively

* Care should be taken to handle major rejections and in prioritizing claims.

* Explanation of benefits should be tallied and documents should be retained for future use.

To Dos in AR analysis and collection:

Root Cause Analysis:

Methodical analysis is essential when handling the denied / underpaid claims. The right approach to the issue will help the analysts in determining the underlying cause for non- acceptance of the claims by the insurance carrier.

* The analysts should take ownership and do a logical analysis to find the cause

* Only deep analysis of the issue can give the clear idea

* Analysts should not arrive at a conclusion based on assumptions

Controlling the error rate:

Majority of the claims get denied due to errors happening before submission of the claims. Error rate should be controlled to avoid unnecessary delays, denials and reworks which will affect the normal work flow and cost huge dollars. Regular review of the error report by the superiors will help in finding the major and repetitive errors that can be avoided in the future. Also educating the coders and billers about the loss incurred due to errors will considerably reduce the error rates.

Insurance Eligibility Verification:

Many claims get denied due to flaws with insurance eligibility verification. Verifying the patientís insurance eligibility can avoid denials due to issues arising out of non compatibility with insurance like elapsed renewal period, claims crossing the limit of allowed benefits etc.,

Following these guidelines will solve most of the issues, reducing the AR days and improving the AR collections.

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