A/R Best Practices

Your billing software’s reporting mechanisms can be extremely helpful in finding revenue leaks, as well as identifying appeals areas and possible “red flags” that might require your attention. Best billing practices require a turnaround time of no longer than 30 days in accounts receivable (A/R). With the technology available to the modern facility, there is no excuse to allow accounts to sit any longer, or to chance lost revenue and missed billing opportunities. It is best to assign not only an administrative person to review your reports, but also a billing and coding staff member to provide guidance and details.

Learning how to decipher the numbers helps you to get a full understanding of what really is going on in the facility. For instance, what is your ratio of appeals to submissions? Monitoring the amount of time exerted on appeals is necessary to determine what type of problem may exist. Is there a particular service being denied frequently? Has your rate of collections declined? If so this could be indications of changes in medical policies that have been missed, or an indication that staff training is required.

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You should also monitor your individual payer contracts and the payment rates associated with them. Such individualized data are a handy tool to deciphering expected payments in the door, as well as inappropriate payment and billing patterns.

Copies of contracts should be readily available so that the terms are easy to load into your practice management software, thereby ensuring that you are alerted if the proper payment is not received. Setting this up initially takes work—you must enter all the information into the system—but takes only a few hours to update annually.

Do not write off denials without a supervising signature. It’s not uncommon for facilities to lose vital revenue because billers incorrectly wrote off charges that should have been paid.

Success in revenue management is in the details. Following your A/R closely allows not only for complete and timely payments, but also provides a first look at what may be a growing trend or problem area in your practice. Such proactive measures are increasingly necessary in an environment of constantly changing rules and government regulations, and help to keep your facility afloat in tough economic times while minimizing the chances for potentially agonizing payer reviews and audits.

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John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 404 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

3 Responses to “A/R Best Practices”

  1. RAQUEL JOAQUIN, CBCS, CPC says:

    While it is important to run the aging reports and work them, it isn’t the best practice in my opinion. The best practice starts with verifying your claims have passed the CLEARINGHOUSE edits the very NEXT DAY after submission. Often times billers fail to take the time to verify the claim passed the first level edits and within 2-3 additional days, look for your ACCEPTANCE REPORTS from the payers. You don’t want to wait until the claim ends up on your aging and notice it 90 days later! They need to identify and correct any issues within a few days. If you depend on your aging report and begin to work the larger dollar amounts in the 60-90 day columns, as most billers do, you have decreased the chance of collecting payment on the claim. Now you are facing timely filling issues and if you have checked you clearinghouse submission reports, you more than likely will find the payer never received your claim if they haven’t sent you a denial by that time. Maybe they did receive your claim but the patient was not eligible at the time of service because the providers office didn’t verify eligibility! In my opinion, verifying ELIGIBILITY, working your CLEARINGHOUSE REPORTS, in addition to working DENIALS DAILY are the BEST practices in A/R. Don’t let the claim end up on your Aging report. :)

  2. Deborah Essen says:

    As a payer analyst at the FI, I agree with Raquel in that the clearinghouse is the first line of defense in knowing if your claims will reject. However, personal experience has taught me that if the front desk personnel are having a personal issue, the billing department will suffer for it.

    Everything rotates off of that front desk. In truth, that is where most billing issues begin. The wrong date of birth, a change in insurance coverages, etc that go un-noticed will reject claims and cause A/R to swell.

    Thanks so much.

  3. Anita Moore says:

    Raquel & Deborah make very valid points. I am responsible for our electronic claim reports from clearinghouse and insurance carriers. It is very important to work them daily. The claims that did not clear the clearinghouse edits return to me and also the claims that do not clear the insurance company edits and the claims rejected from insurance company as patient not being eligible. If good information is entered from the front desk, checking eligibility, verifing patient demographics then claims are clean and will be processed within 14 days. I love working our electronic claims reports and investigating and correcting claims. I work on numerous insurance company websites checking patients eligibility and coverage. I get the rejected claims back out within 2 to 3 days of recieving the reports. I agree the front desk is vital to the A/R process. Usually,the front desk employees are entry level employees, they really need to be seasoned employees since their job is very important.

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