Measurement and analysis of your accounts receivables (AR) should be performed on a monthly basis. The analysis of your AR will alert you to problems that may exist in the reimbursement process.
by Mario Fucinari, D.C. in Billing and Fees on Monday, July 06, 2015
Problems in reimbursement may not always be with the insurance carrier. Inefficient employees or improper billing procedures should also be considered.
The best way to analyze your AR is with an aging report. By running an aging report on a monthly basis, it will analyze outstanding monies that are 30 days or less out, 90 days out and 120 or more days out. A total of 90 percent of your accounts receivables should be in the 30 days or less category. When you are seeing a growing percentage of your receivables in the 90 days or more category, there is a problem.
If you are filing claims electronically, you should analyze for those claims within 15-30 days. If there are outstanding funds, there may be a problem with the payor. Issues such as third party payers holding payment beyond limits may have to be investigated.
When the payer is the cause for the delay, a call to their customer service department is warranted. Frequently I hear from providers who inform me that they not have been paid by Medicare in two years! Investigation usually reveals the claim is missing a modifier or other essential information, or the NPI of the provider or corporation is missing.
If you are a non-participating provider with Medicare or an out-of-network provider with other carriers, the carrier is under no obligation to provide you with an explanation of benefits (EOB). In those cases, you want to either pay for the EOB or have the patient contact you if their expected reimbursement does not materialize.
Even if you are non-participating or out of network, you still are liable for possible fines, penalties, recoupment and even jail time if you are not providing medically necessary services. The EOB may alert you to problems in your procedures.
An Unfortunate Situation
If you compare the current receivables to those that are listed 30, 60 and 90 days out, and if the amounts are essentially unchanged, then the staff is not filing the claims. The insurance company likes a clean desk and so does your staff.
When a staff member is stuffing claims in a desk or shredder, most doctors do not realize a problem exists, until the staff person eventually quits or is fired. Unfortunately, this is all too common.
Once the report is generated, your policy must be that the AR report will be placed on your desk.
Take the time to study the report. After all, it is your money.