The medical billing cycle is a crucial part of the revenue generation process for any healthcare service provider. A/R or accounts receivable management is essential in the medical billing cycle. A/R denotes the monetary amount a healthcare provider is liable to receive from insurance providers for the medical services provided to the patient. A perfectly pitched A/R management system ensures minimal to no claim denials and quick reimbursements.
A/R management involves handling the insurance payments, pending payments, appealing the denied claims, handling the pending transactions for immediate payments, etc. Most healthcare providers have a very opaque idea of how A/R management works, which leads to a significant revenue loss. Many do not even address the denied claim to file an appeal. Understanding the significance of A/R management in medical billing is crucial to improving the overall billing cycle.
Management of denied claims and pending payments:
There could be many reasons behind a claim getting denied. Reasons such as delayed claim filing, lack of patient information, compromised patient information, use of improper medical codes, and charge entry often cause denied claims. It is up to the A/R management to address these denied claims, understand the reasons behind denial, and file an appeal against it. Most insurance providers have a time window for a healthcare provider to file an appeal. Having an active A/R team will only reduce the time spent sharing information between healthcare providers and insurance providers, thus shortening the billing cycle. It will help you get paid for your services as quickly as possible.
Follow-ups are necessary for any business, as it helps in tracking your progress and avoiding mistake at the right time. The A/R management has to follow up on the filed claims in process, held, or denied. Follow-ups are essential to maintain a constant flow of revenue. Instead of waiting for an official mail or notice from the insurance providers, follow-ups can help in knowing the state of filed claim and quickly act on it.
Sometimes, the patient must perform the billing as a part of copayments. In such a case, the A/R management should also follow up with the patient. With the trend of self-pay, the liability of paying for a medical service falls entirely on the patient. In such cases, patient-follow ups become extremely necessary.
A/R management is more important than you think. As the A/R ensures a constant flow of revenue, it reduces the stress of documentation and follow-ups on healthcare professionals. Conducting frequent audits by the A/R management provides an understanding of the reasons behind pending payments, claim denials, and the areas of improvement for a billing cycle of an organization.
As discussed, the A/R management handles everything related to the insurance payments and denied claims. Hence, having a well-trained and responsible A/R team speeds up the process of managing denied claims and clearing pending charges. Having a dedicated team handle such areas, the healthcare professional can effectively focus on providing the care and ensuring a satisfied patient.