One of the main reasons your medical business has an accounts receivable team is so they can ensure your company brings in as much of the money you’re owed as possible.
Your staff does their best to follow up on your AR, but their process produces less than ideal results due to a number of factors we’ll elaborate on below.
Depending on the size of your practice and the amount of claims you process, you may have individual claims timing out every single day that will never get paid. But why?
Let’s look at an example claim, a complicated one that covers multiple expensive services that your company provided for just one of your patients.
After the necessary services were rendered, your team generated a claim via the outdated legacy software they have no choice but to use. Then, that claim made its way to a clearing house, then on to the appropriate payer, and – eventually – back to your team for review.
There’s only one problem at this point, but it’s a big one. The insurance company denied payment for every single service your practice provided because the claim did not comply with adjudication rules specific to that payer.
Here, you might think, “No big deal, they just need to make some changes and resubmit the claim.” But that’s much easier said than done.
Each payer requires both the diagnosis and service line coding to be done in a very specific way and the particular team member following up on this claim may or may not be familiar with those requirements and stipulations.
Because your AR team has no way of ensuring that particular claims get handled by team members with payer-specific knowledge, the claim gets tweaked and re-submitted, only to be denied and sent back to your office again.
At this point, this claim is pretty low down on the priority list because it’s much older than many other claims your medical practice needs to process. Consequently, the most inexperienced member of your team reviews the claim again. Your other, more senior team members were unable to meet the strict adjudication requirements of this specific payer and, sure enough, your newest team member achieves the same result.
While this whole cycle runs its course, your team is submitting and following up on other claims that are both more and less recent than the one that’s been denied three times. To make matters worse, a similar wheel-spinning process may be occurring for many other claims as well.
The filing window is timing out for many of your claims because you simply don’t have enough staff to proactively:
- Manage the flow of claims out of your practice
- Oversee the follow up process for each claim
- Identify and resolve issues
Solution: Change the Culture
The reality is that billing staff jobs have become menial and are generally underpaid. What’s key to attracting and keeping a team of high performers? Create a culture that’s different from your competition. You should also use the funds you’re saving by breaking free of the recruit-train-lose-replace cycle to reward employees for their successes.
We often advise our clients bring in new leadership for their AR department. The new leader can lead your team in working backwards from the end of your AR list forward. We recommend this method so any aging AR can be addressed before the appeal window closes.
Identify ways to reward employees for:
- Successful AR recovery
- Leveraging all the tools available to them like using appeals
- Any outstanding work they’re doing
For a more in-depth explanation of how you can get your staff to follow up on your AR and solutions for the nine other most common AR sins, download our eBook today. In our next blog, we’ll look at AR Sin #2: Improperly Trained Staff.
To book a consultation with the RCM Brain team, call 1-855-RCM-BETH or fill out our online form.