4 Effective Medical Accounts Receivable Recovery Strategies

Are denials and write-offs getting out of hand? It’s possible that it’s time to reconsider your accounts receivable strategy. An effective healthcare AR recovery strategy can result in faster payments and overall better financial performance, but where should you begin with such a complicated process?

The Importance of EFTs and ERAs

All of the best medical billing companies are aware about the importance of EFTs and ERAs lets further look at EFT and ERA how the can improve AR

When possible, look at Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA) enrollments for all payers.” To begin this process, identify paper payments and remittances received and then determine if EFT and ERA enrollments are available. Doing so can expedite payment delivery and make it easier to reduce posting errors.
Because most payers now allow EFT and ERA enrollments, you can focus on ERAs to see payment, underpayment, and denial trends.

Determine the Origin of Denial Trends

The second AR recovery strategy is to figure out what’s causing the denial trends you’re seeing. When working with insurance claim denials, it is critical to identify payer trends as well as the root cause of denial trends, and to develop action plans to prevent future related denials.
The significance of knowing the payer’s CAS codes. While all payers use the same CAS Codes, not all payers use them in the same way.
As a result, it is critical to remember that there may be differences in how the CAS Code is interpreted. Some may, for example, use CAS Code 197 (authorization required) to deny claims that were not processed due to credentialing issues.

In contrast, we frequently see small insurance companies use CAS Code 197 as if pre-certification/authorization/notification were not present. Because CAS Codes can be interpreted differently, denials should not be made solely on the basis of the CAS Code definition.
Review CAS Codes by payer group instead, and link CAS Codes based on your knowledge of the specific payer using them. Identify payer trends and begin determining the root cause of the denial, and you will be able to correct multiple denials more quickly.

No Response to Claims

Claims that are submitted but do not receive a response pose one of the most difficult challenges because those in charge of claim follow up tend to think, “I’ll give it more time,” assuming a response is on the way. However, this isn’t always the case, and the worst response you could get is none at all.
Knowing how long it typically takes an insurance company to accept and process a claim, as well as state insurance processing and payment laws, can greatly benefit your AR recovery strategy. Knowing the respective state prompt pay statutes allows you to use them as leverage to reduce claims processing delays.

In contrast, we frequently see small insurance companies use CAS Code 197 as if pre-certification/authorization/notification were not present. Because CAS Codes can be perceived differently, denials should not be made solely on the basis of the CAS Code definition.
Review CAS Codes by payer group instead, and link CAS Codes based on your knowledge of the specific payer using them. Recognize payer trends and begin determining the root cause of the denial, and you will be able to correct multiple denials more quickly.

Engage Patients As Needed

The fourth AR recovery strategy is to contact your patients as needed. Patient outreach entails writing letters to your patients requesting assistance with the claim resolution process.
The letter should address benefit coordination, insurance payment delays, demographic information needed from insurance, and why insurance is delaying or failing to process the claim (s).

When contacting the patient for assistance or information, inform them of all the efforts you have already made to get their claim paid. Sharing this information with the patient can help build trust that you are doing everything possible to work with the insurance company to get the claim processed. When there are issues with the insurance company during the claims processing cycle, patients are usually eager to assist.

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