AR & Denial Management Billing Care Solutions is the main area to focus if practices want to successfully achieve their business goals. If a practice is having an effective accounts receivable and denial follow up strategy, only then the accounts balances show a positive outcome. If a practice lacks the expertise required to manage accounts receivable then it’s a sure way to lose a major portion of their revenues and sometimes without knowing about it. In a similar way, if medical billing resources are not following up denied claims with a clear strategy then they would fall through the cracks and would not be reimbursed anytime soon.
Account Receivable Management
According to the American Medical Association (AMA) reports, between 1.38 percent and 5.07 percent of claims are denied by insurers on the first submission. It is a very pivotal part of any medical & non-medical providers to maintain account receivable management in smooth and timely manner. AR & Denial Management is the process of collection of work including identification of denied/unpaid claims, re-filing of the corrected claims from aging slots.
Denial Management
During the last decade, healthcare has undergone a lot of transformation. Not only physicians and medical practices have changed to a different working style, processes and technologies, insurance companies have transformed as well. Insurance companies are devising new plans to compete a saturated market with insurance plans that can paint a desirable picture for buyers. They are offering insurance coverage with low premiums but higher deductibles.
The medical billing professionals of Care Billing Solutions are proficient in handling all types of claims, insurance companies and medical specialties. If your practice is experiencing claim denials and aging receivables, then stop worrying about it and reach us for a free consultation session.
Common Reasons for Medical Claim Denials
There are number of reasons why insurance companies refuse to pay to care providers for the medical services they have rendered to an insured individual. While some of the causes stem from simple problems that are easy to fix, others involve complex changes and may even be incorrigible. Among the multiple reasons for health insurance denials, here’s a list of the most common ones.
- Pre-certification/ authorization not obtained when required
- Incorrect documentation
- Delayed filing
- Outdated insurance plan
Tips to Avoid Medical Claim Denials
Most healthcare claims are denied due to common reasons such as furnishing incorrect/inaccurate information, filing claims for services not covered by the patient’s insurance policy, delayed claim submissions, and others. Regardless of the reason, the bottom line is that it’s the patient and the provider who bear the brunt of the colossal medical bills. Some tips to avoid Denied Claims are:
- Determining the cause
- Correct prioritization
- Accurate eligibility check
- Prior authorization checks
- Leverage automation for accurate claims
How Billing Care Solutions increase reimbursement rate and save your business financially?
Billing Care Solutions is here to assist you with your AR Management through our well- organized process where our AR department reviews and categorize the denial reports, rejection Code, Reason Code, containing information on denials and write-offs Trends. The audit team investigate and analyzes previous denials trends and pass the correct instructions to the billing department in order to reduce the error rate in future billing. Then analyze the denial issues log and review the trends in insurance denials that had been identified in order to determine whether the actions taken were effective enough to reduce similar denial in future.
Our Audit department investigates and prepares AR trends reports and their top priority to resolve your account receivable issues such as demographic and claim entry errors, inconsistency in Billing, Coding and modifiers errors, Claim Adjustment Group Code, Claim Adjustment Reason Code (CARC), Remittance Advice Remark Code (RARC), provider credentialing and enrollment contract negotiation matters, Investigate claim on file submission status through Electronic Data Interchange (EDI) 837 professional and institutional or EDI file.
We are among fastest growing Revenue Cycle Management Companies and we tailor our services according to your practice and business needs. We drive your business in new directions of financial growth.
- Investigate, Classify, Organize, Monitor, Prevent Account Receivable financials
- A/R categorized by financial payer’s and Patient Financial Services
- In-depth knowledge on insurance rejections & denials management
- Identify Health plan products, Administrative policies, and Network adequacy
- Identification and diagnoses of the issues in order to fix them to get faster reimbursements
- Regular and consistent follow up of practice aging reports