ACCOUNT RECEIVABLE FOLLOWUP
Our A/R Follow Up service is designed to increase Revenue Collection for Physician offices. The process begins after the Doctor’s biller creates and sends Health Insurance Claims (Electronic/ Paper claims or Manual HCFA forms) to various Insurance companies. Depending on the transmission type and length of time since submission we begin our follow-up:
Electronic Claims: Follow-Up begins 10+ days after submission.
Paper/HCFA Claims: Follow-Up begins 20-45 days after submission.
There are two types of claims Follow-Up:
- No remark claims: Any claims in which absolutely no status is known for the claim.
- Last remark claims: Any claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis. The reasons for rejections include :
- Authorization Issues
- Referral Issues
- Medical Necessity and Medical Records requests
- Non-Participation with Insurance Network
- Terminated Insurance
- Coordination of benefits
- Wrong Diagnosis
- Inclusive Procedures
- Partial Payments
- Out-of-network claim status and deductibles
- EDI Rejections
- Letter of Protection from Attorney cases
- No status and No claim on File
- Worker’s Compensation
- PIP cases
The Follow-Up process is divided into 3 methods:
- Online Claims Follow-Up – Using various Insurance company websites and internet payer portals we check on the status of outstanding claims.
- Automated Claims Follow-Up (IVR) – By calling Insurance companies directly an Interactive Voice response system will give the status of unpaid claims.
- Insurance Company Representative – If necessary calling a “live” Insurance company representative will give us a more detailed reason for claim denials when such information is not available from either websites or Automated phone systems.
Once the Follow-Up process has begun Denied Insurance claims will require extra effort for resolution. Denials management is divided into two categories:
- Claim Correction and Resubmission: These are the claims which are corrected, modified, and resubmitted as a corrected claim to Insurance companies. For such claims every effort is made to resolve the denial to avoid billing the Patient.
- It’s becoming more challenging for physicians to get paid for the services they perform. Medical practices face increased pressure to collect more money and cut their operating expenses.
- Our A/R Follow Up service is designed to collect more money for Your Practice. We start AR follow up process after claims are created and sent to the insurance company. Our aggressive follow on claims ensures that no lost or ignored claims slip through the cracks and that the appropriate action is taken for all of them.
- Unfortunately, most medical practices are not collecting everything they have billed. Only 70% of claims are paid the first time they are submitted, other 30% of claims are denied, lost or ignored. And of those claims, 60% of them are never resubmitted to payers. Also, when services are paid, they aren’t necessarily being paid in full according to their payer contracts.