Medical Accounts Receivables Services Outsourcing

healthcare accounts receivable management

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By Pratik H

The procedure of outsourcing a physicians or hospitals Accounts Receivables or any other medical office function, doesn’t begin with just passing on the accounts and sitting back to see what happens next.

In its place, Accounts Receivables Management begins with some reasonable amount of understanding and planning, on what advantages Healthcare Accounts Receivables outsourcing will deliver to your hospital.

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This implies that once Accounts Receivables are outsourced for Supervision, the Business will already have a clearly defined plan on what to anticipate, in addition to how they can redirect their now free resources, from supervising receivable accounts directly.

In general, the basic advantages of outsourcing  Accounts Receivables Management for a Medical facility, consist of:

  • customer service (both outbound and inbound calls) 
  • collections (bad debt and/or pre-collections)
  • payment processing,
  • statement generation in a number of instances

Ensuring that all patients are satisfied instead of keeping them antagonistic, and ultimately, making sure that Ageing is under control, and on schedule.

Nonetheless, there are more advantages and benefits that meet the eye. Comprehending how all these benefits can manifest makes the procedure way easier to implement.

Why do medical office face so many claim denials?

Let us take a look at Medicare, for instance, thought these could apply to other 3rd party insurance firms as well, such as Media Card.

Medicare medical claims normally get denied for the following listed reasons:

  • Duplicate claims
  • Services improperly claimed
  • Missing or incorrect quantity of services (services allocated without quantity getting quoted or with manifold quantities specified in error on claim)
  • UPIN or Physician’s name incorrect or missing
  • Missing or incorrect Current Procedural Terminology (CPT) process code
  • The claimed bill amount being incorrect
  • Extra information required to process the claim
  • Missing or incorrect CPT- 4 modifiers
  • Missing or incorrect ICD 10 diagnoses.

As you can perceive from the list above, a vast majority of reasons for hospital claim denials include, incorrect medical billing and incomplete or incorrect data entry.

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Delayed collections and outstanding claims place extra administrative strains on physicians and hospital procedures.

On the one hand, insurance firms normally deny claims or even refuse to pay them altogether.

On the other hand, Federal conventions have become excessively stringent in the United States of America.

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Recently, all federal centers for Medicaid services and Medicare services publicized that they would minimize the period of time given to physicians, so they can file a petition against a medical claim denial from 6 months to just a hundred and twenty days.

This obviously over burdens the staff at your healthcare practice affecting follow up on appeals and denials.

That said, How You Can You Avert from Compensation Delays for Healthcare Claims?

Outsourcing agencies help you avert from compensation delays (payment delays) by following these simple steps.

1. They review all your claims prior to submission

This prime step significantly cuts down on the error rate. The firm will spend their time on appraisals at the front end, instead of spending a longer period of time later dealing with every denial.

2. They maintain a coding and billing claims evaluation log

The firms and agencies also track the trends for every healthcare Business Process Outsourcing (BPO) provider, based on the transmittal advice from Medicare in addition to the “Explanation of Benefits” (EOB), from every third party payer.

They monitor and evaluate all these trends to  find ways and means to fix problems resulting in the rejections and denials of your claims.

3. They perform once a month billing reviews

All the employees involved in account receivable functions, i.e., Those who execute tasks such as analyzing denials, payment and billing posting, documentation and coding, data entry, and down coding come together at least, once every month to evaluate.

They practice complications that are appropriate to the billing task.

Prior to listing the benefits brought about by outsourcing Hospital accounts receivable, let us take a look at why accounts receivable follow up is vital in medical billing.

We all know that the number of services offered by nursing homes, physicians, and hospitals is constantly increasing. Every single time patients receive treatment or care, they owe an assured amount of cash to the hospitals or physicians.

This amount owed helps healthcare service benefactors run their practice, with ease and success.

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Why Should Healthcare Service Providers Set Aside A/R Teams Dedicated to Just Accounts Receivable Follow Ups?

Account Receivables follow up teams are accountable for reopening and looking after denied claims so they can attain maximum repayments from insurance firms.

Revenue cycle and Medical billing Account Receivables Management handled by in house teams are now a thing of the past. Nowadays, these services demand billing specialists with specialized skill-sets to look after Accounts Receivable follow ups.

It must be stated that besides Accounts Receivable Follow ups, there are numerous other imperative procedures such as payment posting, charge entry, and verification that ought to get completed first.

Amidst these procedures, medical billing specialists determine the precise diagnosis codes and procedure codes, based on the treatment plan.

Like stated before, there are pretty good chances that insurance firms might deny the claims, in case they do not adhere to their rules and regulations. As a result, it is vital to have dedicated A/R teams who specialize in following up with these insurance firms and resolve denied claims.

The Three Phases of Hospital Accounts Receivable Follow Up Procedures.

Most medical billing professionals execute the follow up procedure in an extremely systematic manner, which is normally conducted in 3 stages.

  1. Initial evaluation
  2. Prioritizing and Analysis
  3. Collection
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Initial Evaluation

This phase involves the analysis and identification of claims listed on the “Accounts Receivable Aging Report.” The A/R teams review provider policies and identify which claims must be adjusted off.

Aging Report - A/R

Prioritizing and Analysis

This stage is initiated as soon as the claims are acknowledged; claims which are marked as uncollectible and claims where the insurance carrier hasn’t paid according to the agreed amount with the healthcare service provider.


All claims identified to fall within filing limits of the carrier get re-filed after authenticating all the required billing information such as, conformation to all medical billing regulations and claims processing addresses.

After finalizing and posting the payment details for unresolved claims, patient bills get generated as per the customer guidelines and then get followed up with the respective patient for disbursements.

To conclude, Let's look at the advantages of outsourcing Accounts Receivables.

1. More advanced Payment and billing procedures

Outsourcing your Medical facilities Accounts Receivables helps streamline your payments and billing procedures, in a number of ways. Devoted automatic reimbursement services might be available and can free up your worker’s time and improve efficiency.

Your outsourcing firms might also have other modes of electronic communication options, that can intensify the diversity of your client outreach as a supplement to conventional ailing options.

2. Minimized Administrative Overhead.

By outsourcing all labor associated with accounting fees, a firm can significantly minimize expenses for both human resource and IT departments. 

Mitigating costs as well as diminishing training expenses of workers is normally associated with upfront investments and might add up well in terms of administrative overhead.

Other advantages of outsourcing Accounts Receivables include:

3. A quick turnaround time is assured

4. Offers more stringent and quality assurance procedures

5. Hospitals get to utilize first-rate infrastructure and technology

6. Outsourcing agencies have dedicated teams, well experienced in working with multiple insurance firms

7. Outsourcing firms and agencies also utilize up-to-date medical accounts receivable software, such as Misys, NetGen, Lytec, Medssoft, IDX, Inception, Medic, and so much more

8. Outsourcing accounts receivable experts are also well versed in collection, medical billing, and medical reimbursements

9. Outsourcing firms also have in-house financial analysts, and even American Academy of Professional Coders (AAPC) certified personnel in their hospital accounts receivable teams

10. With their intensive experience in following up with insurance firms, you’ll not have to miss any other account receivable

11. Outsourcing firms have a proficient workforce who can assess your business needs and provide you with a modified business clarification

12. You can benefit of cost savings for more than 40 percent

13. You will receive weekly and monthly reports, with full details regarding cash collection analysis, expected collections, insurance analysis, and even procedure code analysis amongst others

14. Experience the competent supervision of all your hospital accounts receivables based on your needs and turnaround time.

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