A/R management is vital after claim submission and crucial for the financial stability of any practice. It aids in comprehending the claim outcome and indicates the adjudication status of the filed claim. Early denial notice prevents the claim from becoming "untimely" for appeals or corrections and aids in its repair at the outset. Our staff will examine your accounts, spot any mistakes, and put in place effective procedures to quickly recover payments and clear any outstanding accounts receivable (A/R).

In any healthcare setting, time and money are directly linked to one another. It is very critical to a healthcare organization’s profitability to have an efficient and effective account receivable and denial management process. With our years of experience, we can significantly improve your business's cash flow, reduce A/R days and decrease unwarranted write-offs effectively.

• Initial Evaluation - This stage involves the identification and analysis of the claims listed on the A/R ageing report. After examining the provider's policy, the team determines which claims require adjustment.


• Analysis and Prioritization - This stage begins when claims are recognized as uncollectible or when the carrier has not paid the healthcare provider at the agreed upon rate.


• Collection - After confirming that all required billing details, including the claims processing address and compliance with other medical billing regulations, are provided, claims that are found to be under the carrier's filing limit are re-filed. Patient bills are prepared in accordance with client instructions once the posting of payment details for unpaid claims is finished, and patients are subsequently contacted to collect payment.

The main difficulty that most businesses encounter during the medical billing process is managing A/R follow-up. Why then is it so crucial? These are a few of the more well-liked explanations:

• Hospital's Financial Stability: Sustaining a positive cash flow is crucial for the financial stability of any provider of healthcare services. The A/R department makes sure that the hospital has a consistent flow of income to cover costs in order to deliver patient care services.


• AR Recovery of Past Due Payments: A/R follow-up makes it easier for all medical facilities, doctors' offices, retirement homes, etc. to get their past-due payments recouped. Having a team that is consistently involved in the claims follow-up process makes it simpler for healthcare providers to get paid on schedule.


• Minimize Time for Outstanding Accounts: Reducing the length of time that accounts are permitted to stay outstanding is the major goal of accounts receivable management. The group monitors delinquent accounts, determines the appropriate course of action needed to ensure payment, and puts safe payment systems into place.


• Claims Never Go Missing: The primary cause of the payment delay is the failure to receive the claim. Usually, when paper claims are misplaced, this occurs. It is advisable to submit the claims electronically to prevent this. If you've followed up on the claim and you know it hasn't been received, then it gets simpler to submit a follow-up claim request quickly.


• Claims Denied can be Followed Up: Depending on the denial reason, you can send a new claim request with the required corrections made. The A/R department can make sure that all claims are pursued to the end by contacting the insurance providers and obtaining the refusal reason rather than waiting to get it through mail.


• Recover Claims Kept Pending for Information: Occasionally, claims are held up for a while because more information about the member is required.

• Follow-up across all payers on outstanding A/R
• Inherited A/R clean-up projects
• Underpayment management
• Denial management
• Credit balance resolution

In the healthcare sector, the typical claim denial rate is between 5% and 10%. The majority of providers view these rejected claims as a financial burden and a waste of resources. But a lot of providers are unaware of how big of an impact it is. Even though 63% of denied claims are recoverable, data indicates that 90% of denied claims are avoidable and that up to 65% of denied claims are never resubmitted. This is money that was not used. Your company can improve payment recovery with the aid of our devoted rejections team and efficient denial avoidance technique. This is accomplished by figuring out the underlying reason for denials, revising the denials, filing appeals where needed, and resubmitting claims.

• Identifying and correcting root causes of denials
• Making contact with patients and payers to obtain additional data.
• Drafting appeals, updating claim data, and resubmitting updated claims.

We can help you achieve a high resolution rate on expensive accounts receivable by using our methodical methodology. Some of our offerings include:

• Thorough pre-call analysis utilizing system notes and EOBs.
• Work prioritization and allocation based on claim age, claim value, payer category, etc.
• Professional team dedicated to staying on top of the collections process
• A/R statistics, denial dashboards, and ad hoc reports
• Fundamental examination of denial patterns and reasons
• Re-engineering and offering pertinent remedies to ensure a healthy A/R.

Our adaptable solutions are made to monitor important KPI's, increase the percentage of clean claims, and streamline your A/R and rejection handling procedures. To put it briefly, you can rely on us to turn your receivables into income.

• Timely reimbursements
• Reduced denial rate
• Reduced A/R days
• Operational efficiencies
• Sustained cash flow
• Low cost to collect
• Quick turnaround time
• Access to skilled and experienced resources
• Cost-effective solutions
• Customized reports
• Claims handled for all payers
• Updated on industry regulations