An important role of the old AR recovery in hospital financial performance
Your hospital’s primary source of un-received revenue is through accounts receivable. Hospital leaders or CFOs often neglect old accounts receivables. They are written off as bad loans and labeled as not collectible, which can lead to poor collections and excessive spending on incorrect billing and staff who do it. These are just a few reasons why working on your hospital’s AR recovery is important.
The expertise of staff:
Most often, accounts receivable (AR) are performed by the same staff that handles the entry-level aspects. They may not be certified coders to review the procedures before they submit the claims. They may need more experience and will focus on daily tasks such as charge capture, entry, and claim transmission. This means they can take reimbursable action against the AR in a shorter time frame. The cost of resolving your hospital’s AR issues is much higher than you think. Over a period of several months, the unpaid claims will add up to around 20%-40% of your net billable charges.
If the issue persists for a while, you could be looking at $100K of unworked AR sitting in 90 and 120+ buckets. These are then sent to collection agents, who charge a percentage of collectibles as their fees. This will result in a lower ROI for your hospital. AR days will be reduced by having certified Accounts Receivable staff within 30 days. AR specialists with 5+ years of experience can focus on the root causes of unpaid AR claims and provide a solution to prevent them from happening again.
Issues global or in bulk
Global issues are also known as global days for surgery. However, this term is used in AR to refer to issues that result in most denied and unpaid claims. It is sometimes called “bulk issues,” as it causes insurance companies not to pay the billed charges. Global or bulk issues can only be caused by contracting lapse, credentialing upgrades, specialty code usage, and non-compliance with CMS or other federal healthcare institutions’ revised guidelines.
These constant threats are why working on your hospital’s old AR recovery is more valuable than you might think. Bulk/global issues require more analysis time than just correcting claims. Your hospital should have AR analysts that can track these issues back to the source point. This will increase your chances of recovering money not paid by insurance companies. Also, resolving these global/bulk issues will stop further claims from being denied.
Problems with house transmission:
In-house billing staff often doesn’t focus on clearing house rejections or transmission, which can lead to 100s of unattended claims in the clearinghouse. Payer ID is another aspect of a clearinghouse. As we have discussed, a single-payer has multiple plans. Billers must identify the correct payer plan to submit claims. Incorrect payer IDs will result in claims being rejected by the payer and no response.
Clearing house transmissions should be checked regularly to ensure that unattended claims are noticed. Also, incorrect payer IDs can be removed from your AR. This will increase the likelihood of getting reimbursements and a clean claim rate.
The Healthcare sector has spent a lot of capital to implement technology solutions that will drive the RCM process. Novita Management Inc. has created sophisticated automation systems that can replicate human staff performance.
Robotic Process Automation in AR
Robotic process automation (RPA), which automates AR analysis daily, is an option for hospitals and medical groups that cannot find qualified staff. RPA bots are recommended for this purpose because they can quickly perform AR analysis and run the next reimbursable in minutes, even if there isn’t any supervision from your billing staff.
AR and RPA
These AR tasks are performed by unattended RPA robots 24/7, 365 days a year. This means that the more RPA is used in your hospital or medical group, the less AR will remain usolved and days of accounts receivable. RPA bots will report daily to the designated staff on the status of claims and the dollar value of any outstanding AR. RPA bots will automatically handle paperwork such as reconsideration, redetermination, and corrected claims. This will allow your staff to focus on high-value tasks and save time.
Novita Management Inc. and our resources say goodbye to their experience in resolving pending and older AR. Over the years, we have recovered over $1 million in unpaid accounts receivables. Hospitals and medical groups looking for a solution to accumulated AR can rely on our AR staff and automated systems. The first step in solving old AR is to get a Lost Revenue Recovery Audit (LRRA). Get this audit free today and use it for our senior AR recovery service.