AR & Denial Management

You can maximize your revenue cycle with our focused accounts receivable (AR) and denial management services. Our main concerns are:

• Monitoring unresolved patient accounts and making sure that timely follow-ups occur
• examining rejected claims to spot patterns and stop problems in the future
• putting into practice practical methods to get back money that was withheld
• We help you increase your AR by effectively managing your profitability and ensuring your practice is sustainable.

Accounts Receivable (AR) Management

Definition:

Accounts receivable management in healthcare involves tracking, managing, and collecting payments owed to a healthcare provider for services rendered. Effective AR management ensures that the healthcare organization maintains a healthy cash flow and minimizes outstanding debts.

Key Components of AR Management Services:

1. AR Aging Analysis:
   • Conduct regular aging reports to categorize outstanding accounts based on the length of time they have been due (e.g., 30, 60, 90+ days).
   • Identify trends and patterns in payment delays to facilitate informed decision-making.
2. Payment Posting:
   • Accurately post payments received from patients and insurers to corresponding accounts.
   • Reconcile discrepancies between payments posted and amounts billed to ensure accurate records.
3. Patient Billing and Statements:
   • Generate and send patient billing statements, detailing services rendered, amounts due, and payment options.
   • Provide clear communication regarding outstanding balances to encourage timely payments.
4. Follow-up and Collections:
   • Implement systematic follow-up procedures for outstanding accounts, including phone calls, emails, and letters to encourage payment.
   • Establish a professional collections process that complies with legal regulations and maintains patient relationships.
5. Reporting and Analytics:
   • Develop regular reports on AR performance metrics, including days in AR, collection rates, and outstanding debt amounts.
   • Utilize analytics to evaluate the effectiveness of collection strategies and identify areas for improvement.
6. Payment Plan Management:
   • Offer flexible payment options and plan structures for patients to facilitate manageable payment arrangements for outstanding balances.
   • Track compliance with payment plans and follow up on delinquencies as needed.

Denial Management

Definition:

Denial management involves reviewing, analyzing, and resolving denied insurance claims. Effective denial management helps healthcare organizations recover lost revenue and reduce future denial rates.

Key Components of Denial Management Services:

1. Denial Analysis:
   • Identify trends and common reasons for claim denials (e.g., coding errors, lack of documentation, eligibility issues).
   • Categorize denials based on their nature (e.g., clinical, technical, administrative) to prioritize resolution efforts.
2. Root Cause Identification:
   • Perform a thorough analysis of denied claims to determine the root causes of denials.
   • Collaborate with coding, billing, and clinical departments to address issues leading to denials.
3. Appeals Management:
   • Prepare and submit appeals for denied claims, ensuring that all necessary documentation and supporting evidence are included.
   • Track the status of appeals and follow up with payers as needed to expedite the resolution process.
4. Payer Communication:
   • Maintain open communication channels with insurance payers to facilitate the resolution of denied claims.
   • Develop relationships with payer representatives to streamline the appeals process and reduce future denials.
5. Proactive Prevention Strategies:
   • Implement training and education for coding and billing staff to reduce errors that commonly lead to denials.
   • Develop standard operating procedures to ensure accurate and compliant claim submissions.
6. Performance Reporting:
   • Generate reports on denial rates, appeals outcomes, and resolution times to assess the effectiveness of denial management strategies.
   • Provide insights and recommendations for process improvements based on denial trends and performance metrics.

Benefits of AR and Denial Management Services

• Improved Cash Flow: Streamlined AR processes and effective denial management result in quicker collections and improved financial health for healthcare organizations.
• Reduced Outstanding Debts: Proactive follow-up and collections efforts minimize the aging of accounts, leading to lower overall outstanding debts.
• Higher Recovery Rates: Efficient denial management increases the likelihood of recovering denied claims through thorough analysis and strategic appeals.
• Better Resource Allocation: Outsourcing AR and denial management allows healthcare organizations to focus on patient care while experienced professionals handle financial processes.
• Enhanced Reporting: Detailed reporting and analytics provide valuable insights into financial performance, enabling informed decision-making and strategy adjustments.

Conclusion

As a service provider, offering comprehensive AR and denial management services allows you to enhance the financial operations of healthcare organizations significantly. By implementing effective strategies to manage accounts receivable and resolve denied claims, you can improve cash flow, reduce outstanding debts, and support organizations in navigating the complexities of revenue cycle management. Tailoring these services to meet the unique needs of each client will further enhance your value proposition.

For denial reason info visit: https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/review-reason-codes-and-statements

For complete medical billing services visit: https://resolvepros.com/services/