One of the most critical things in running a medical practice is efficient AR management. If not resolved quickly, rejected and unpaid claims can build up and seriously affect your cash flow.
Claims are rejected due to various reasons: invalid or missing codes, illegible claim fields, missing provider ID, coverage is terminated, incorrect coding or other incomplete information. Managing AR involves following up on unpaid claims, examining the reasons for denial and taking appropriate measure to ensuring reimbursement. Your practice would need a team on the job and this more manpower and infrastructure costs.
- Checking with the clearing house for rejected claims
- Analysis of the reasons for rejected claims
- Assessment of Explanation of Benefits (EOBs) and follow-up of unpaid claims without delay
- Correction of errors
- Resubmissions of claims
No claim is written off without being appealed first. Every appeal is accompanied by the necessary supporting documents and a letter stating clearly why the claim should not be rejected. Medical necessity letters are provided as proof of why the procedure or treatment is justified.
The AR follow-up team establishes effective communication with the insurance companies to dispute and negotiate denials using the right techniques. Phone calls are made to the insurer continually till the issues are resolved. In addition to this, patients are contacted for missing information and for enquiries on their accounts.
Reports are an essential feature of efficient claim denial management service. The reports help track claim denial issues so that steps can be taken to prevent them from recurring.
It’s quite obvious that managing AR is a full-time task that needs great attention to detail – a very good reason why you should outsource it.
Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.