Objective:

To collect all the outstanding money both from the patient and the insurance company and maintain a “0” balance in the patient’s account.

Process:

Once the charges are entered into the system for an account, the claims are transmitted to the various insurance companies. The claims either get paid or denied. If the claims get paid the same is accounted into the system, if the claims are not paid then the same has to be followed up with the insurance companies exactly after 30 days in the case of paper claims or 15 to 20 days in the case of electronic claims. If the claims are denied then the billing company has to analyze the reason for the denials then resubmit the same after fixing the reasons for the denials.

Team:

The AR team consists of an analyst and a caller. The same can be increased based on the volume of the business.

Analyst:

The analyst keeps track of all the clams submitted to the insurance company and short lists all the claims which are either not paid within 20 to 30 days based on the type in which the claims are submitted, and analyze the reasons of all the claims which are rejected based on the various reasons. To manage this show efficiently and effectively the analyst maintains the list of claims transmitted to various insurance companies on a daily basis. This person has extensive a knowledge on the billing process and the rules and the regulations of the insurance and the billing process, and additional knowledge on the claims adjudication process. The AR analyst is also responsible for allocating the work to calling department based on the AR days and monitoring the workflow of the calling department. The analyst also updates the team on the latest information they receive from the insurance company such as address change and policy change.

Calling Team:

This team follows up with the insurance company and the patients for all outstanding amounts that are due. The calling team calls the insurance company and inquires about all claims which are pending with insurance company after the 15 or 30 days of the submission based on the types of submission (electronic and paper). The caller will also call the patient for balances that are owed by them to the provider. The caller also calls the provider’s office to inquire on certain issues, which can be resolved, only by the physician’s office.

Denials Management:

The insurance company can deny a claim for many reasons. The AR Team ensures that all the denials are corrected and resubmitted correctly to the insurance company.

Co-ordination:

Based on the reason of the denial, the AR team coordinates with the charge, cash and the demo entry department to fix the issue. Overall, the analyst has to act as a coordinator and communicate with the various inter departments regarding the updates and the other bulletins he or she receives from the insurance company.