Back-office revenue cycle functions include claim submission, payment posting, denials handling & resolution, accounts receivable follow-up, and others. All these functions must be taken care of by billing experts to ensure accurate practice collection. Providers have to spend a lot of time on these back-office functions due to high employee turnover, billing and coding updates, changes in guidelines, and practice-related policy changes.
Providers also have to spend time on setting goals for performance improvement initiatives, education of staff, regular meetings, performance discussions, and attention to detail on all aspects of the revenue cycle. In this blog, we have shared some of the tips for improving these back-office revenue cycle functions which will add to your bottom line.
Tips for Improving Back-Office Revenue Cycle Functions
Claims Submission
- Submit claims daily: Submitting new claims daily will ensure that you will receive quicker payments. Even though your claim got denied or rejected, you will have sufficient time to correct the errors and resubmit them. Submitting claims daily will reduce your AR days and will also help in timely patient collections.
- Quickly reply to denials/rejections: When your claim got denied or rejected, act quickly. Understand the denial reason, quickly correct the error or if asked provide additional information or attach documents. Quickly working on denials and rejections will ensure quicker payments and reduced AR days.
- Maintain staff: It’s easier said than done but maintaining a staff that knows claim submission and practice policies is a difficult task. You might use some common procedural codes, a set of diagnosis codes, common claim details like billing address, provider details, and patient demographics. If you manage to maintain your staff, it would help to reduce common claim rejections. Your regular staff will be able to submit claims regularly without much input.
Payment Posting
- Accuracy is crucial: Your staff’s ability to read EOBs, ERAs and then posting the payments accurately is a crucial part of your revenue cycle. If you are able to read remittances accurately then only you will be able to assign responsibility for the rest of the collection. Insurance companies will accurately share remittance reports along with how you can appeal any denied claim.
- Read each line item: As discussed earlier, payment posting consists of not only posting payments but also posting adjustments and denials. Since insurance companies may deny an entire claim or just deny one line item on a claim, it’s important to have high attention to detail. It’s also impossible to retroactively find a denied line that is inadvertently included with the adjustment or part of the patient’s responsibility.
- Look for Secondary payers: Most billing systems will submit secondary claims electronically unless there are edits within the systems. Note that if the primary payment is posted with errors the secondary claim may go to the insurance company with mistakes.
Denial Management
- Track every claim: A most crucial part of revenue cycle management is tracking every claim. Practices focus on only submitting clean claims and anticipate insurance collections. You have to ensure the claim report is properly interpreted and denied claims are separated from paid claims. Root cause analysis should be done to find out errors or requirements of additional information.
- Modify process: A denial may indicate a missing pre-authorization/referral. In such a case you have to find out who was responsible for preauthorization and why it was missed. You have to modify your process accordingly to include preauthorization in the billing process at the right time. If a claim is denied due to insurance non-coverage, a person responsible for eligibility and benefits verification should be enquired.
AR Follow-up
Accounts receivable follow-up should be taken by dedicated specialists who are trained to follow up with insurance companies. Their role is to find out why a claim is processed incorrectly or not yet processed. Twenty percent of claims could be processed wrongly and need work to be done. If AR follow-up is taken properly, it will boost your insurance reimbursements.
Back-office roles and functions in the revenue cycle are critical to the success of your practice, and outsourcing these functions with a partner firm has many benefits—not the least of which is saving you and your people time and effort while improving the revenue cycle performance.
You’ll have access to potentially cost-prohibitive technologies to help achieve best practices, as well as resolve any difficulty with recruiting, retaining, and educating qualified staff members.
To know more about our back-office revenue cycle functions contact us at info@medicalbillersandcoders.com/ 888-357-3226
FAQs:
1. What are the key back-office functions in the revenue cycle?
Key back-office functions include claim submission, payment posting, denial management, accounts receivable follow-up, and maintaining accurate records.
2. Why is daily claim submission important?
Submitting claims daily speeds up payment processing, allowing for quicker corrections of any errors and reducing accounts receivable days.
3. How can I improve payment posting accuracy?
Ensure staff are well-trained in reading EOBs and ERAs, and pay close attention to every line item to accurately post payments, adjustments, and denials.
4. What should I do if a claim is denied?
Act quickly to understand the reason for the denial, correct any errors, and provide additional information if needed to expedite resubmission.
5. Why is dedicated AR follow-up necessary?
Dedicated AR specialists can effectively track claims, identify processing errors, and ensure timely reimbursements, ultimately boosting your practice’s revenue.
