Revenue Cycle Management—Improve your bottom line from the bottom up!

There are many top level accounts receivable (A/R) management processes—verifying insurance, ensuring charge entry accuracy, tracking rejections, working denials in a timely fashion and, of course, using data analytics. If these processes worked perfectly in a perfect world, we should have no outstanding A/R issues. I haven’t visited that practice yet!

Virtually all organizations have trouble spots. Many times, you will find the answers only when you drill down to the specific data at a claim level. When consulting with groups with A/R problems, I look here first.

How do you get to the bottom of your A/R problems and work them upward? Take your claims more than 90 days overdue and sort by payer. Run the report at a line-item level. Look for repetitive patterns in what remains unpaid. Many times, you’ll find the claim partially paid with residual line items outstanding. Was it a non-covered service or was it linked to the wrong diagnosis, missing a modifier or bundled with another procedure? You have to get the root of the issue, resolve it, and find a way to prevent it from continuing.

Don’t get me wrong, top down processes and analytics are crucial, but so is the importance of claim-level digging. Working your A/R at a line-item level will likely reveal coding errors such as medical necessity issues, bundling, or non-covered services. Take these issues and resolve them in batch mode, which will prove more time-efficient as well as easier on your billing staff. Most importantly, ensure staff understand the issue. Many times, unpaid dollars remain on your A/R simply because staff did not understand the problem.