{"id":8832,"date":"2019-10-21T05:28:43","date_gmt":"2019-10-21T10:28:43","guid":{"rendered":"https:\/\/www.billingparadise.com\/blog\/?p=8832"},"modified":"2026-03-26T02:15:32","modified_gmt":"2026-03-26T07:15:32","slug":"top-15-hospital-account-receivable-management-kras-billingparadise","status":"publish","type":"post","link":"https:\/\/www.billingparadise.com\/blog\/top-15-hospital-account-receivable-management-kras-billingparadise\/","title":{"rendered":"15 Essential KRAs for Healthcare Accounts Receivable Management"},"content":{"rendered":"
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How AR Backlogs Can Harm Your Hospital\u2019s Revenue?<\/strong><\/span><\/h2>\n<\/div><\/div>
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Hospitals must be working hard to plan out a strategy for 2026.If you are busy creating objectives and setting revenue goals for your healthcare organization, The 15 Most Important Hospital Account Receivable KRAs will immensely help you chart out a plan to achieve your AR objectives.<\/p>\n

No matter how big or small your organization is, this well-researched study will better equip your organization to structure decisions that will enhance levels of efficiency in AR management<\/a>.<\/p>\n<\/div><\/div>

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The media has been reporting many stories about several hospitals closing down, because they had huge AR backlogs, with the cash flow parched, running day-today operations or paying salaries to staff becoming arduous, eventually these organizations pull their curtains down.<\/span><\/p>\n

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\u2018Backlog\u2019 of Collections Leaves Hospital Unable to Pay Employees\u2019<\/strong> screamed the headline of an online post featured by \u2018accountsrecovery.net\u2019. It reported that a small hospital outside\u00a0 of Pittsburg, Ellwood City Hospital has not paid its employees in more than two weeks, because of a \u2018significant backlog in accounts receivable collections<\/a>\u201d. <\/span>Being the only hospital in a 30-mile radius, nobody in the community wanted to see it closed, but with \u2018upset\u2019 staff who had not received their salaries,\u00a0 the operations would be too difficult for them to run.<\/span><\/p>\n<\/div><\/div>

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When it comes to managing a huge AR backlog, the first step always begins with analyzing. Ever since the proportion of patient-paid AR progressed, running reports is an important element towards resolving the backlog. The next step obviously\u00a0 would be to split patient AR from the insurance AR.<\/span><\/p>\n<\/div><\/div>

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Managing a huge AR backlog is a collective process needing optimised speed, setting up dedicated teams of claim processors<\/a>, claim auditors, and claim adjustment analyst. A comprehensive strategy has to be established, with a step-by-step approach to gradually clear the backlogs.<\/span><\/p>\n<\/div><\/div><\/div><\/div><\/section>

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1. Knowledgeable AR Management Team<\/b><\/span><\/h3>\n<\/div><\/div>
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The capability of handling denials, and working on the claims<\/a>, and taking corrective measures, are important key essentials. Being part of the RCM process,<\/a> each member of the team must also have a firm\u00a0 knowledge analysing data, and AR calling abilities.<\/span><\/p>\n<\/div><\/div>

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Importantly, a team with a comprehensive AR knowledge is the key to the efficacy of AR management. The roles and responsibilities of an AR management team<\/a> includes calling insurance companies, and following-up on claims, checking and updating claim status.\u00a0<\/span><\/p>\n<\/div><\/div>

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Key Focus Areas for a Strong AR Management Team<\/strong><\/h4>\n<\/div><\/div>
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A Knowledgeable AR team will concentrate on all areas of claim management. According to colburnhill.com dynamics is particularly obvious in the area of low balance claims, which have been generally viewed as worth only a cursory squeeze, and not given the full refolding treatment. Some organizations have consciously de-emphasized claims with payer balances as large as $5,000. Compared to the larger and fresher claims available in a brand new tube, individual low balance claims are small and costly to work. However, when taken collectively, they add up and likely hold as much as 1% of a hospital\u2019s net revenue, yet often don\u2019t receive the attention they deserve. To squeeze the maximum amount out of AR, it is vital to first understand the barriers to collecting these claims, then offer some suggestions about how to assess the scale of this problem in your organization, and finally review solutions to the problem.<\/p>\n<\/div><\/div><\/div><\/div><\/section>

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2. Accelerating the AR process Through Automation<\/b><\/span><\/h3>\n<\/div><\/div>
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Another important aspect of AR management is having the most efficient <\/span>software<\/span>. An AR Analyzer that easily integrates with the hospital\u2019s EHR<\/a>,\u00a0 with data storage capabilities within the application, and without having to shuffle from one system to another to access AR data.<\/span><\/p>\n<\/div><\/div>

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The application must also have analysis features to segment receivable accounts, especially the high risk receivables. It should make it easier for the AR team to run and review multiple reports and AR summaries in a single window.\u00a0<\/span><\/p>\n<\/div><\/div>

The reports generated by the application should enable the AR team to manage AR days<\/a> and AR relationship with payers.\u00a0 Above all, the security of the stored data must be well secured, with multiple layers of security, and in absolute compliance with HIPAA.<\/span><\/p>\n<\/div><\/div>

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What\u00a0Becker’s Hospital Review talks about accelerating the AR process through automation?<\/h4>\n<\/div><\/div>
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According to Becker’s Hospital Review<\/a>, with more than 90 percent of claims deemed preventable by the Advisory Board, introducing automation and updating technology systems for claims processing will help decrease denial write-offs and cut administrative costs. Accounts receivable for payment delay and denial classification mapping as a prime starting point for intelligent automation. The first step is to request or locate any open or closed denial information, then the organization can use historical and current claims data to categorize inventory. Robotic processing automation technology can also be especially helpful for grabbing information the organization may not have access to through its own system.<\/p>\n

Once the payment delay and denial classification mapping data is categorized, the organization can move forward with implementing the intelligent automation and triage process. This ultimately allows claims to be classified and distributed to the organization’s remediation team based on denial category, and the automation tool can develop a summary of all relevant claim information and compile a list of action items for staff.<\/p>\n<\/div><\/div><\/div><\/div><\/section>

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3. Setting Up Benchmarks as per MGMA Standards<\/b><\/span><\/h3>\n<\/div><\/div>
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Having basic benchmarks setup for billing<\/a> as per MGMA standards is a judicious exercise, one which facilitates the efficacy of workflow, especially relating to\u00a0 AR.<\/span><\/p>\n<\/div><\/div>

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As an example, aging categories for account receivables must be setup for benchmarking days in A\/R as per MGMA benchmarking standards<\/a>, so that the AR team can improve collections in a particular aging category, while comparing them to the benchmarked standards.<\/span><\/p>\n<\/div><\/div>

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Listen to Kristina B. Ziehler, MPH about setting up benchmarks as per MGMA standards<\/h4>\n<\/div><\/div>
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According to Kristina B. Ziehler, MPH<\/a>, is assistant director, data solutions, for the Medical Group Management Association (MGMA). AR aging is one of the key components of MGMA Standards. Kristina says \u201cLet\u2019s start with the percentage of accounts receivable (A\/R) in each aging category. When reviewing this particular benchmark, your company wants the majority to be in the 0- 30 days in A\/R category. After that, the percentage should be lower as the receivable ages. When benchmarking days in A\/R, you want to compare yourself to the mean (or average). Based on this, your billing office would want to look at ways to improve their 0-30 days in A\/R benchmark since it is lower than the MGMA benchmark. Other opportunities for improvement exist in the 120-plus day\u2019s category. Often, these receivables are never collected. As such, efforts and improvements must be made to collect earlier in the process.<\/p>\n<\/div><\/div><\/div><\/div><\/section>

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4. AR Workflow and Reporting Tools for Healthcare<\/strong><\/span><\/h3>\n<\/div><\/div>
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Another \u2018plus\u2019 to have for the efficacy of AR collections is a<\/span> workflow<\/a> and reporting platform<\/span>.\u00a0<\/span><\/p>\n<\/div><\/div>

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It leverages the account receivable team to access detailed revenue cycle reports<\/a>, which can amalgamate AR and denial management reports<\/a>, claim management reports, medical billing and coding reports, top paying insurer reports, trend analysis reports, and MGMA benchmark reports. These reports are useful for setting up department specific goals, and viewing individual level productivity data.<\/span><\/p>\n<\/div><\/div>

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RevCycleIntelligence\u2019s Top 5 Recommendations for AR Reporting<\/strong><\/p>\n<\/div><\/div>

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Workflow and Data Analytics platform is one of the top five ways to optimize hospital revenue cycle management<\/a> according to article in RevCycle Intelligence.<\/a>\u00a0 The five recommendations include:<\/p>\n