Accounts Receivable Management Services

After you bill claims, one of four things can occur: they can be paid accurately, they can be paid

inaccurately, they can be denied, or they can vanish into thin air.

Accounts receivable follow-up has been the workhorse of the revenue cycle process and has functioned to clean up unpaid claims. These follow-up processes have included generating reports on the status of individual accounts, denial follow up, payment discrepancy review, rebilling activities, secondary billing and also credit balance research and adjustment.

While improving effectiveness in the patient registration, charge capture, coding and claims submission processes are significant, claim follow up teams remain a necessary and effective method for protecting cash flow as well. Practices cannot afford a high number of days in outstanding receivables as this represents cash that could be paying bills or growing the company.

Challenges:

• Denials represent the state of the highest financial exposure since all costs have been incurred and payment is still outstanding. Denied claims usually cost a provider $ 14 each to handle an appeal.

• Greater than 20% of all accounts receivable is greater 120 days old

• Accounts not being worked timely and effectively exhausting all efforts

• Timely filing payor guidelines

• Claims that have been pending the longest are in the most danger of not being paid because they have

potentially surpassed timely filing deadlines. It is always important to know the carriers’ policies

and work those claims as priority that have the strictest timely filing guideline.

• Tracking the number of additional information requests from carriers

• This can help determine a root issue related to coding, or may indicate a payor contract issue.

Key Performance IndicatorsBest Practice Standards
Insurance A/R aged more than 90 days from service date15%
Insurance A/R aged more than 180 days from service date5%
Insurance A/R aged more than 365 days from service date2%
Bad debt write-offs as a % of gross revenue2%
Net AR days30 days

LEGACY CONSULTING offers the following services:

• Run detail aged outstanding accounts receivable report for creation of custom collector worklists.

• Provide payor and effective accounts receivable follow-up training to collectors.

• Establish daily and weekly goal of accounts to be worked.

• Weekly supervisor meeting with each collector.

• Provide custom accounts receivable reports by practice by financial class, by physician, by payor, etc.

• Custom worklists for carriers based on filing limit so that those with shorter filing limits can be systematically worked prior to the deadline and those with longer filing times can be worked next.

• Tracking number of accounts outstanding, the number of accounts that have been worked, and the collections actions associated with these accounts.

How LEGACY CONSULTING differs from other RCM companies and what this all means for you:

• Reduction in accounts receivable greater than 90 days from greater than 20% to less than 15%

• High-balance follow-up completed by dedicated accounts receivable team

• Staffing levels sufficient to minimize/prevent aged A/R build-up

• Regular quality control reviews of collectors’ work

• Collectors cross-trained on more than one payor type

• Collector specific work list assignments presented in descending balance order by payor

• Use online, third-party payor inquiry systems

• Collectors receive third-party/guarantor follow-up training and scripts

• Underpayments and full denials are identified at time of payment posting and promptly addressed

• Follow-up timeframes are set appropriately for each stage of follow-up on outstanding claims.

• Quantity and quality of productivity by collector is measured and discussed routinely with collectors.

• High dollar, high risk account review weekly meetings to assist in resolution

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