Revenue Cycle Billing: All You Need to Know

Do rejections and denials seem to be getting out of control? In order to ensure a smooth revenue cycle billing, it appears that it is time to review your AR recovery approach. A successful plan for recovering outstanding debt can result in quicker payments and greater financial performance overall. But it’s critical to understand where to begin and how to get started. Revenue cycle billing denials and unpaid claims cost healthcare practitioners a sizable amount of money. Therefore, by rethinking and appealing to the insurance payer, such lost revenue can be recovered. Following up on insurance company denials until full reimbursement is refers to as AR recovery. Best medical Billing services help out you in this regard

Aging Report of Account Receivable in Revenue Cycle Billing

• Denials are often categorized using the number of days for outstanding payments in the account receivable aging report.
• The requirement for AR recovery in revenue cycle billing is explained by the fact that chances for reimbursement decrease as claims in the aging group age.
• Accounts receivable departments that have efficient denial management procedures and follow-up teams are able to amend rejections. And makes requests for payment while conducting frequent follow-ups until the money is receive

Keeping track of and examining your medical billing reports

• By keeping track of all the claims to see if payments were made, denied, or delayed. It is feasible to assess the collection percentage and identify the claims that the accounts receivable team should follow up on.
• Establishing a reliable monthly reporting system that tracks your practice’s income flow can help you improve the efficiency of your revenue cycle billing.

Metric-Driven Objectives for a Better Financial System

• Each healthcare facility sets its own objectives and performance standards.
• To maintain a successful and forward-moving revenue cycle billing process, financial targets serve as important barometers.
• Processing more claims each month without considering anything other than an increase in patient visits won’t help you reach your financial objectives. By ensuring maximal collections, a practice achieves its goals.
• It’s also essential to make sure every dollar your medical practice has received from the insurance company was legitimate.

Having a Successful AR follow-up with your billing cycle revenue

• Clearly, an efficient AR follow-up can keep track of all low- and denied-paid claims and assess them in accordance with the provider’s write-off and adjustment policies.
• Using the insurance company’s appeal and timely filing deadlines. All claims that have not been paid at the agreed-upon rate are located and pursued.

Important Facts about EFTs and ERAs

• First of all, where feasible, practices “definitely must consider enrolling all payers in Electronic Funds Transfer (EFT) and Electronic Remittance Advice (ERA)”.
• You can identify paper payments and remittances received to begin the aforementioned procedure, and then you can check to see if EFT and ERA enrollments are accessible.
• These procedures speed up payment distribution and make it simpler to cut down on posting errors.
• Insurance companies often do not allow EFT and ERA enrollments. In order to see trends in payments, underpayments, and denials, you might focus on ERAs.

Find the main reason for the denials

• Finding the source of the denials is a step in an AR recovery approach. It’s crucial to identify payer trends and the underlying causes of denial trends when working with the insurance companies claim denials and to develop action plans to stop similar denials in the future.
• Christina also emphasizes how crucial it is to comprehend the payer’s CAS codes. Even though insurance companies utilize the same CAS Codes across the country, not all of them do it in the same way.
• For the same reason, it is important to be aware of the possibility that several individuals may understand the CAS Code differently.
• Blue Cross Blue Shield, for instance, has the right to deny claims not handle properly. Because of credentialing-related concerns by using CAS Code 197 (permission required).
• Small insurance providers, on the other hand, usually employ the CAS Code 197 as pre-certification, authorization, or notice missing in its most basic version.
• There are various ways to interpret CAS codes. The definition of the CAS Code should not be the only standard for handling denials.
• Instead, make an effort to review the CAS Codes by payer group and link them in accordance with your understanding of the particular insurance payer using them.