What is AR follow up in medical billing and its importance?

The sheer size and number of services provided by healthcare providers, nursing homes, and hospitals are continuously increasing. Every time patients receive care services, they owe a certain amount to healthcare providers or institutes. An effective insurance model will help healthcare organizations recover overdue payments on the insurance providers’ side. This is precisely where the AR follow up in medical billing comes into the picture. The AR recovery process in medical billing helps healthcare providers run their practices smoothly while ensuring the owed amounts reach them as soon as possible. Medical billing services and AR follow-ups are interconnected processes that provide timely, effective reimbursements.
Let’s explore the following:

3 Stages AR follow up in Medical Billing

The AR follow up in the medical process is a systematic process that has three stages, including:

1. Initial Evaluation

The first step of the AR follow-up process consists of identifying and analyzing claims listed on the AR aging report. The billing and AR team here reviews the insurance provider’s policy and identifies which claims need adjusting-off.

2. Analysis and Prioritizing

The second phase in AR follow up in medical billing is analysis and prioritizing, post the claims identification. The identification and analysis process helps mark the claims deemed uncollectible – or the claims that carriers have not yet paid out according to the contracted rates.

3. Collection

The last phase for AR follow up in medical billing is collections. After identifying that the claims are under the filing limit of the carrier, the refiling process takes place with the verification of all necessary billing information. The information includes the claims processing address and confirmation of the other medical billing rules. After the completion of posting payment details for the outstanding claims, the patient bills are generated following the client’s guidelines. The last step is following up with patients regarding the payment of the said patient’s bills.

Significance of the AR Follow up in Medical Billing

The process inside medical billing services calls for special skills – including:

Billing
Coding
Denial and AR management

The financial health of a healthcare practice is dependent on maximizing reimbursement rates, in addition to maintaining a positive cash flow.
Payments mustn’t be delayed, denied, or lost for effectively providing patient care and covering expenses. By thoroughly understanding the billing guidelines and keeping a trained billing staff in place, your practice can reap the benefits of the high first-pass acceptance rates. The first-pass acceptance rates also mean shorter billing cycles.
However, even when everything is right – some of your claims will be rejected or denied. The teams for AR follow-up in medical billing are responsible for taking care of such claim denials and reopening them for receiving the rightful reimbursements from insurance providers.
Simple mistakes can easily hold up the claims, so you will be surprised that over half of the rejected or denied claims never get reworked.

What does that mean?
It means the average healthcare provider leaves thousands of unclaimed dollars yearly.
Let’s explore some key benefits and the importance of AR follow up in medical billing.

1. Claim Follow-up

Not all submitted claims in medical billing reach their intended destination—the insurance carrier. Electronic filing can reduce the loss of claims, ensuring a smooth payment process.
Quick follow-up is essential to identify any delays in claim processing. Waiting weeks before realizing that the insurance firm never received a claim can harm your practice’s cash flow.

2. Managing Denied Claims

A practical approach to handling and managing denied claims is essential. Rather than waiting for paper denials via mail, the A/R team can contact the insurance firm to understand the reasons behind denials.
By addressing denial reasons swiftly, the A/R team can accelerate the correction process, resubmitting claims up to 7 days earlier and significantly reducing the payment turnaround time.

3. Recover Overdue Payments

An expert A/R follow-up team advocates for healthcare providers, ensuring that late payments are recoverable without any hassles.
The team analyzes the explanation of benefits carefully, resubmitting claims with the required information to secure overdue payments and maintaining a healthier cash flow for your healthcare practice.

4. Provide Financial Stability

The financial stability of a medical practice depends on positive cash flow. A robust A/R management department is a guardian, ensuring timely payments and receivables for covering expenses and facilitating effective patient care services.

5. Manage Pending Claims

Pending claims, often awaiting additional information, can become a problem in the revenue cycle. A hands-on A/R team mediates, notifying members quickly to speed up the process and maintain a steady flow of revenue.

Collections from AR follow up in Medical Billing

Collection is where multiple activities take precedence after analyzing the claims issues. The claims become refillable if they are within the filling/appealing limit of the insurance company. The entire process runs around accurately validating all necessary billing information.
Furthermore, some claims get appealed with the necessary supporting documents. These are the claims which are underpaid by the insurance provider. This appeals process depends highly on the plan, state, and insurance provider.
Next, all claims are transmitted electronically, directly to insurance companies. Furthermore, in the case of other carriers, the claims go through clearinghouses. After which, all of these claims are aggressively followed by the insurance providers for confirmation.
These days, the complex nature of medical billing and the piling of denied claims – make medical practices look for billing experts with the necessary skill set to look after their AR follow-ups. That brings us to:

The Need for an AR Team Who Can Follow Up on Claims

Multiple procedures and processes come first, including payment posting, charge entry, and verification. During these processes, a medical billing specialist determines the diagnosis and procedural codes – all based on a patient’s treatment plan. Even after doing all of this – there are still chances that an insurance provider will deny the claims if your claims do not follow the rules. This is why it is essential to have a dedicated AR team. A team that can follow up with the insurance companies to resolve all denied claims.
The importance of AR follow up in medical billing cannot be overstated. Most medical providers face multiple challenges, including the long receivable cycles, which essentially:

Delay the revenue
Tires out billing teams
Frustrate the overall financial management
Destabilizes the practice cash flow

Outsourcing AR follow up in medical billing to an experienced services provider can bring you peace of mind with skilled professionals focusing on your practice’s AR management. This way, healthcare providers can stay focused on their core competencies and effectively and smoothly overcome multiple challenges.

Conclusion

AR follow up in medical billing is essential to successful healthcare revenue cycle management. AR directly impacts the financial health of healthcare providers and practices. Healthcare providers can sustain a steady cash flow by effectively tracking and resolving outstanding claims while reducing revenue leakage. Furthermore, effective AR management also enhances the overall RCM efficiency. Secondly, timely AR follow-up is essential for addressing potential denials, billing errors, and rejections to prevent reimbursement delays and improve patient experiences.