ACCOUNTS RECEIVABLES AND CLAIMS ANALYSIS PROCESS- AN OVERVIEW

What is Account Receivables?

Receivables are defined as amounts due and expected to be collected by billing / provider’s office for the services provided to individuals. In Medical Billing, receivables are handled by Account Receivables Department. Account Analyst plays a crucial role in identifying and resolving issues which helps to reduce or clear receivables.

What is the purpose of Claims review & AR Analysis?

The purpose of claim analysis is to identify and resolve medical claims billing and reimbursement issues toward maximizing collections and minimizing accounts receivables. It helps to ensure timely, accurate and final settlement of health insurance claims and patient bills by insurers or patients as appropriate. The scope of claim analysis is applicable to all health insurance claims and patient bills that have not been fully and finally settled by liable party or parties comprising health insurers, patients and others. It is the responsibility of the Accounts Receivables Analyst to ensure that AR is under control & acceptable by industry standards.

What is the scope of AR Department?

AR Department has to ensure steady inflow of money from the insurance company. The main motive of this department is to collect money for all the treatments taken by the patients in a timely fashion. Usually the turn around period for the payment by the insurance company is 30 – 45 days. Once the limit is exceeded AR department has to make an enquiry for the delay. There are various reasons for the delay like:
e) Correct details may not have been provided to the insurance companies.
f) Claims were sent correctly but Insurance Company may not have received the claims.
g) The checks issued might have been sent to the wrong address.
h) The insurance company may delay the payments if they have a backlog and they would inform us by a letter that they have received the claims and would be making the payments shortly.

AR department acts as a hub around which other departments revolve. This department can gather & update lot of billing information which is required to settle a claim. Account analyst uses various reports available in billing software to identify claims which have not been settled.

The Medical billing software is capable of running reports that pull out claims that are unpaid for greater than 30 days. These are called aging reports and these reports show pending payments in slots such as 0 – 30 days, 31-60 days and 61-90 days. Claims filed within the last 30 days will find themselves in the first slot (0-30days). Claims that are more than 30 days but less than 60 days old will be found in the 31-60 days slot. A glance at this report will show the AR personnel the claims that need to be followed up on with the insurance company.

Claims will be followed up over the telephone or by written correspondence. It would be necessary to find out why the claims are yet to be paid and what needs to be done to have these claims paid. The delay and denials will be corrected by the billing office in coordination with the physician’s office and the insurance carriers. The same applies when patient billing statements are sent out. The patient is given 3-4 weeks to pay the bill and if the payment is not received with in that time, the billing office will follow up with the patient