Turning over accounts
receivable into cash requires a
systematic, planned and focused
approach. Each effort must be
aimed at eliminating or
resolving the problem instead
of merely gathering
information. Documentation of
the findings is critical as it
helps as a reference tool for
the future.
The problem researched by A/R
agents internal data entry
error, incorrect information on
the claim, non-covered benefit,
unauthorized procedures and
services, procedure or service
not medical necessity,
pre-existing condition,
termination of coverage,
failure to obtain
preauthorization,
out-of-network provider used,
lower level of care could have
been provided etc.
Working
on delinquent accounts:
Verifying health plan
identification cards on all
patients.
Determining patient's health
care coverage to ensure that a
pre-existing condition was not
submitted for reimbursement on
the claim.
Electronically submitting a
clean claim, which is correctly
completed standardized claim
CMS-1500 (HCFA-1500) or UB-92.
Contacting the payer to
determine that the
claim was received.
Reviewing records to determine
whether the claim was paid,
denied, or is in suspense
(pending) such as subject to
recovery of benefits paid in
error on another patient's
claim etc.
Payment
Posting:
Payments postings in
clients systems as per the
Check amount and EOB's.
At present, we can handle 600
EOB's / Checks per day.
The capacity can be enhanced
as per the clients?
requirements in a phased
development process.
We ensure that 100% accuracy
rate in payments postings is
maintained through a
two-tiered audit/review
process consequently resulting
in balancing of all the
batches at the end of the day.
We take immediate actions on
under-paid and over-paid
claims with appropriate
information to A/R team to
file appeals and posting of
excess amount in the suspense
account.
Implement
the solution:
Once the action plan has
been drafted and confirmed the
next step is to implement the
solution to all the outstanding
claims that fit the criteria
for such action. This is vital,
since problems falling into the
same category are fixed at one
go.
|