A/R follow-up and collections have become a pandemic-wide challenge for many medical practices and facilities: private, publicly traded, and not for profit. The shift to a work-from-home environment and the continued risk of exposure has had negative consequences for both A/R balances and collections.
The aging of A/R and delivery of timely follow-up for healthcare providers is even more pronounced during this pandemic. Because healthcare services are considered essential, business in the healthcare sector has continued. For many medical billing teams, the change in work flow the pandemic has created is having a negative impact on the billing process and cash flow.
It is ALWAYS important to focus on and reinforce the fundamentals of A/R follow-up. By focusing on the following fundamentals, the personnel disruptions caused by COVID-19 can be minimized through sound and routine processes.
We have summarized these processes in this checklist for A/R follow-up.
STEP 01: Review your billing system’s A/R Aging Report
Make sure your A/R Aging Report is created regularly and reviewed at the very least monthly. The expectation should be that all outstanding claims are statused and worked every 30-45 days. Identify those payers where A/R balances are becoming delinquent and look out for balances moving from one aging bucket to the next. Avoid missing timely filing limits.
The Medical Group Management Association (MGMA) provides cost surveys each year for medical practices. These surveys do include A/R metrics. Here are some basic A/R statistics you should regularly measure your group’s performance against.
|Aging||0-30 days||31-60 days||61-90 days||91-120 days||120+ days|
If your group’s results are not equal to or lower than these percentages, this may indicate your group has an A/R problem.
STEP 02: Analyze and Organize Outstanding Claims by Issue/Action
Take the time to review and analyze all outstanding claims and organize them by follow up action or issue. A FIFO (first in, first out) approach is not always the best approach. It is important to prioritize claims and have the flexibility to quickly reassign claims. A $5,000 surgery claim should take precedence over a $100 office visit. Claims easier to address should be assigned to a junior billing specialist allowing you to assign higher dollar and more complex claims to your veteran team members. Be sure to assign the more difficult payers and/or claims to your experienced staff members. This will have a positive impact on your group’s collections. Spend time analyzing the root cause of your denials. Is the denial related to a front end issue? Two common causes for denied claims and that are often easy to rectify are data entry errors and failing to verify insurance eligibility. A smart approach would be to correct the source of the problem instead of trying to fix the issue when a denial is received. This will help speed up cash flow and eliminate frustrations.
STEP 03: Create a Specialist or Expert Action List
Don’t let bottlenecks occur. When a billing representative is faced with a claim that is more complex and requires additional expertise to resolve, encourage the billing representative to look to the SPECIALIST OR EXPERT on your team for assistance. By parking complex claims, junior billing specialists can continue moving through their claim queues and avoid wasting time on claims outside of their experience level. Create an environment where your team shares information. Your goal should be to make your junior claim representatives into seasoned veterans.
STEP 04: Communicate and Be Supportive
We recognize many senior billing specialists, although being skilled at resolving more complex claims, do not like to work these claims because they often cause frustration. It is important to communicate and explain why the experienced and typically most tenured, billing specialists are being assigned the “worst” claims for follow-up. Recognize WINS with your team. It is important for managers to offer supportive reminders that:
STEP 05: Focus on Perpetual Progress
Your billing team should focus on making continuous progress. There will be times when there are more delinquent and denied claims than your team can process; and that’s ok. Stay focused! Get done what is possible and avoid creating frustration by demanding unobtainable results. Be mindful of those claims that are going to generate the most amount of revenue as well as those claims that may be coming up on timely filing limits. A positive spirit will create positive results.
At MRG, we specialize in medical billing, A/R follow up services, coding and compliance, and provider credentialing. We hope this fundamental A/R follow-up checklist can help you and your team get back to the basics and help you better manage your accounts receivables.
If you identify payers or A/R buckets that need additional analysis and follow up, we offer cost effective solutions that can assist your team with these challenges. These engagements are often short term to help with resolving delinquent claims – and ultimately helping our clients avoid losing additional revenue.
To learn more about MRG, please visit our website: https://www.mrgllc.net/.