It is true that accurate medical coding highly enhances the chances of maximizing reimbursements from insurance carriers, and thus can be termed the soul of any medical billing revenue cycle. But in the same breath A/R services or in other words Accounts Receivables is the engine that pulls the collections towards their intended revenue goal, and thus is equally important in realizing the monthly/quarterly/annual reimbursement targets in order to keep the practice hale and healthy.
But chances are that many a small practice has no such thing as a dedicated Medical Billing Team; leave alone an Accounts Receivables Department. So what are they missing here? If there is no Accounts Receivables operating within the confines of the practice, then it goes without saying that no one is keeping the vigil, so as to speak, till claims submitted come back as EOB or Explanation of Benefits. Even then a non-professional caller, such as for example your medical records supervisor, may neither have the time or the inclination to follow up on the many denials.
Chances are that in such a scenario aging/denied claims are unlikely to see the light of the EOB day once again. And if as a small practice, say maybe less than a year old, you are thinking “why in god’s name have I not broken even still”, the answer is evident.
It stands to reason then that you go ahead and recruit an outside A/R specialist, someone who has on its rolls dedicated and experienced callers, who make sure that the claims submitted never exceed the 90-day limit. Someone who gives you monthly reports about where your claims stand exactly, a denial report with percentages and reasons for denials, and resolution reports which outline the steps being taken by the company for redemption of denied/underpaid claims through shrewd followup and appropriate strategy.
