How AR Specialists In Medical Billing Are Important For Effective RCM

 

Medical billing aims to improve the inflow of money for the service providers. This is where AR specialists in medical billing play an important role. Accounts Receivables (AR) Management  is the department of medical billing that deals with claims which need a settlement or where the payments are still to come from insurance companies.  The reason for this can be denials, over-payments, claim not on file &  partial payments etc.

 

AR(Account receivables) plays a vital role in medical billing as it is the responsibility of the AR department to clear the fog and get a clear picture of claims. They need to think over points like how we can get the payment, what lacks in a claim or if the claim is not payable then what is the exact reason in terms of the patient plan or Insurance guidelines. Also, AR needs to clarify that if a patient is responsible for any liabilities then how much amount is chargeable? Moreover, if the patient cannot be billed, how should we handle the charges – either by credit adjustment or written off.

 

The medical billing process takes months to complete. It is a fact that 100% success on the submitted claims is very hard to achieve. Denied claims, delayed payments, outstanding payments & follow up on denials are all part of medical billing. The account receivable department handles all these activities. Without the efficient working of AR specialists, the outstanding payments and ageing denied cases can increase to alarming levels.

To understand more about the significance of the AR department, we need to analyze its functions.

 

The Functions of AR Specialists In Medical Billing:

 

 1. Ensure Consistent Flow of Income :

 

Whether anyone likes it or not but money is the blood of any business whether anyone likes it or not but money is the blood of any business. The health care sector is no different. Without account receivables working efficiently, it is very hard to maintain a consistent flow of income for any Doctor’s office, DME supplier, hospital or clinic. Insurance claims can prove to be a complex process. The reason being constant updates and changes of provisions that are part and parcel of the medical billing line.

 

2. Effective Patient Followup & Satisfaction :

 

The AR  team professionals make calls to patients to verify demographic details or missing information, and also discuss outstanding dues. Moreover, no patient wants to get stuck in the web of documents, coding and other necessities while getting treatment. An effective AR team make sure that follow up on the denied cases happen smoothly and the ageing claims do not occur. An efficient medical billing company that has an effective AR team is always more successful in keeping patients happy.

 

3. Take Corrective Actions for Non-payments:

 

The Account receivable team get input and data from the follow-up team regarding non-payments.  AR analysts compile all claims details for analysis and initiate corrective actions for non-payment. They conduct a deep analysis of the data to find the recurring pattern to make sure they do not get repeated.

 

4. Research On The Denied & Rejected Claims

 

They also examine low payments by carriers, rejections from the clearinghouse and denied claims. It is a fundamental part of their duties.

 

5. To Maintain Optimum AR Days Value:

 

It is important to maintain the good health rate of ‘AR days’. It is a very helpful measurement to know if your  AR health is good or bad. To measure the AR Days you can use a formula:

 

Formula – AR Days- Yearly gross charges/365

 

To calculate the average daily  gross charges you need to divide your yearly gross charges by 365.

 

What  Are The Good Practices Of A Sound AR Department:

 

  • Effective Denial Management:

 

Denial management is perhaps the most important task that an AR team carry out. Identifying the cause of denial management early, & resubmitting the claim without delay is very important. Furthermore, the AR team needs to find out the persisting trends that are causing higher denials and take corrective steps.

 

  • AR Follow  UP:

 

If claims are not paid within the 30-day period, then an effective AR team shall take action without delay. It is their responsibility to ensure there are no overdue payments or underpayments.

 

  • Make Use Of Best Software:

 

Manual AR working is effective, however, with time technologies have refined the AR  working to great extent. Choosing the right software and upgrading it from time to time is significant. Moreover, it might be necessary to re-skill existing employees as soon as possible on the new software.

 

Conclusion:

 

AR specialists in medical billing are an integral part of medical billing. All receivables are important for Revenue Cycle Management and not giving priority to AR can erode the RCM significantly. An AR department needs to do multiple tasks efficiently, such as managing denials, maintaining periodic records, and managing aged receivables. Therefore, managing  AR is significant. Virtual Healthcare is a professional medical billing company that follows modern and ideal AR management practices. You can rely on our services to get your RCM  in the best possible shape. Call us to know how we can help you overhaul your medical billing.

 

 

 

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