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As of now, the US Healthcare industry is undergoing many regulatory and compliance changes that are making it hard for Physicians to conduct their daily activities. Healthcare providers are on the lookout for various techniques and software solutions to streamline their workflow, and adhere to the latest rules and regulation.

Billing Companies and the Changing payment modes

It is vital for medical billing organizations to guarantee that their end customers get paid till the last cent either by insurance provider or patients to augment their income and decrease the number of unpaid claims because of timely filing deadlines. Then again, billing organizations additionally need to guarantee that each claim is paid the right sum according to the Fee Schedule, Contracted rate, UCR and so forth and are not underpaid. Underpayments and inability to appeal on underpayments make huge income losses to providers.

With a specific end goal to accomplish set goals, a solid Accounts Receivable administration team is required who follow up on each claim till they get paid in full. However because of resource crunch, time difficulties and inefficiencies, a huge amount of money is lost by the provider when AR follow ups or appeals are not done convenient and successfully.

Indeed, even the most grounded AR teams of AR follow up specialists or claim denial experts tend to concentrate on high dollar claims and since practice has an expansive volume of low dollar claims, a few cases go through the crack which either sit in the AR inventory and increase the AR days drastically. Writing off such claims makes the AR days look good, but are of no use as cash flow is still stagnated.

Managing Medical Billing through Workflow Management Tool

A powerful and technically advanced AR Work Flow Management system (WFM) helps the AR team to automatically organize and work on different parameters, like, Insurance filing limit, offer appeal limit, dollar value and much more. It likewise helps the AR teams to identify possible billing and coding issues faced by physicians, insurers and the medical billing and coding company, by using real-time information benefits on the claims processed with expanded efficiency and quality.

WFM systems additionally helps the billing organization with dashboards with various metrics like unworked claims, amount of time to resolve a claim, claims that are missed follow up on due dates, break up of AR issues by different categories like coding, credentialing, billing etc. All this helps to identify the issues across different departments and provide training, curative and precautionary actions to ensure maximum reimbursement.

In particular the WFM device gives Clean claim rate (First pass ratio), payments acknowledged through AR efforts (follow up calls, Telephonic/paper appeals) and through patient documentation and statements. Along these lines a compelling AR WFM system will guarantee that no cases are going through the timely filing and appeal deadlines which are made stringent by the insurance agencies.

Published By - Medical Billers and Coders
Published Date - Apr-28-2017 Back

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