Ideally, when a healthcare provider dispenses medical care, patients pay their bills on time, and insurance companies reimburse the provider promptly so that the provider has a constant, reliable revenue stream. It is not uncommon, however, for payments from either patients or insurance carriers to become overdue for various reasons. This is when accounts receivable, or AR, must become involved. Accounts receivable follows up on unpaid or denied claims and reopens them when necessary to ensure maximum reimbursement. It is vital that this is done systematically because the process is often too complicated for a small in-house team to effectively handle.
Accounts payable follow-ups are done in three stages. First, claims are analyzed to identify whether they need to be adjusted or reopened. Second, they are prioritized to determine which claims are the most important or pressing. Third, claims are refiled, and new patient bills are generated as a result of those claims. These stages seem simple, perhaps even routine, but it is imperative to do them in a correct, precise, and efficient manner. They are essential for many reasons: the provider’s financial stability, overdue payment recovery, account processing time, claim tracking, follow-ups, and claim recovery. Therefore, providers should help accounts receivable function at its best capacity, using goals, strategies, and carefully planned execution.
Since accounts receivable handles problematic claims that may not have otherwise been paid to the provider, it is vital for a provider’s continued financial stability. Providers cannot always count on the majority of their fees being paid as billed without additional effort on their part. Since healthcare providers are an essential service and their revenue is not guaranteed, maintaining a revenue stream at all times is vital so an organization can continue to function. Accounts receivable helps recover overdue payments, and this is best accomplished when a team is consistently in contact with patients and insurance companies owing unpaid fees. Without constant oversight, it is easy for overdue payments to slip through the cracks when more and more new patients and procedures flow into the provider’s systems. A dedicated accounts receivable team minimizes the amount of time that accounts go unpaid. That is its primary objective, and the job is to obtain and encourage payment whenever possible.
Accounts receivable teams make sure that claims don’t go missing. This is easier in the digital age than it was when most claims were provided on paper. The biggest reason for payment delays is that claims are not received. This can happen due to errors in technology, but it is much less likely when using electronic billing, and it is much easier to follow up or resend claims should something go wrong. Denied claims can be followed up quickly, and accounts receivable teams should have processes in place to address and resolve various common denial reasons. Claims that can be rapidly fixed, for example, should not need processes as long as those that have complex coding or structural problems. All claims, whether successfully submitted or not, should be followed up upon in some way by the accounts receivable team in order to make sure that nothing falls through the cracks. This is particularly important when claims are purposely kept pending because additional information is needed. The accounts receivable team can follow up to get the additional information required and then speed up claims processing as much as possible.
It is crucial for providers to know exactly how the accounts receivable team functions, what resources its members have at their disposal, and how flexible processes are. Hidden inefficiencies in processes, unclear workflows, or productivity delays can lead to lost revenue. This can affect the financial stability of the provider in both the short term and long term. Planning a successful accounts receivable team from the start is important. When done right, this team can function well in the present and be prepared for changes in the future, whether those changes are the result of technological advancements, standards updates, or new personnel.
Teams should set short and long-term business goals. These goals should focus on individual projects which can be done one at a time as part of a greater whole. Immediate goals, such as resolving a specific claim, should be balanced with larger goals like increasing efficiency. Sometimes, new goals are required when urgent issues arise that need attention. All of these goals should have a strategy with respect to how they can be accomplished. Teams should analyze what they are doing right and how they can improve, as well as how each of their activities might impact their goals. Strategies should be flexible and able to be revised as goals change. Providers change over time, and accounts receivable teams should be ready for that. Executing these goals and strategies requires organization and planning. Internal organization of an AR team is vital, but it’s also important to organize payers and contacts. Different payers have different rules, guidelines, and specific requirements so that new processes might be required for some of them.
Maintaining an accounts receivable team that is organized enough to handle the present and flexible enough to prosper in the future can be a challenge. Through having a suite of solutions, a team can rely on increases in productivity and keep its members from getting bogged down in mundane tasks. The eReceivables software suites can streamline the day-to-day and long-term tasks faced by accounts receivable teams, and it can help ensure that providers always have a steady stream of revenue. Contact eReceivables today for more information.