Medical Billing- Effectively Manage Accounts Receivable With Advanced System Tools

Medical Billing- Effectively Manage Accounts Receivable With Advanced System Tools

To effectively manage healthcare accounts receivable, several advanced system tools are necessary to make sure that the workflow and efficiency of your practice is optimized. Some of the features that will give you the best return on the time and money spent are:

Work Queue: For your collectors, the system needs to be able to send, sort and route assignments to collectors via an informative automated list so they can work quickly. To collect, they need to be productive at addressing delinquent accounts and document activity.

Routing by Skill Set: You want to assign projects according to your staff’s skill sets both in terms of experience and efficiency. This means that your system should include employee assignment based on predetermined criteria. For example, a Medicare denial could be automatically routed to a Medicare specialist.

Sophisticated Tracking: Your practice needs to be able to track all denials, lost or neglected claims, underpayments and non-payments. To do this, the system must be able to categorize them as such. This will result in an organized work process and flow.

Intuitive Usage: The GUI (Graphic User Interface) system interaction needs to be as easy and intuitive as possible. You’re seeking a minimal-click process for resubmissions, appeals, eligibility verification and demographic and insurance information changes. Again, this goes back to the focus on staff productivity.

Electronic Status Checks: You want to be able to electronically check on your claim status with your payer (many payers allow this). That way, you will know when to expect a payment or follow up on a claim. It also means that your system has to be able to interface with the systems used by your various payers or set reminders on accounts within your practice management application.

Advanced Sorting and Storing Ability: Make sure your system contains ways to easily organize your A/R data. For example, you might want the system to sort claim denials by payer, provider, billing amount, payer type and any other category. Not only should your practice effectively store the data, but it should be easy to access and extrapolate data whenever it is needed.

Value of Denials: You need to know how much claim denials are financially impacting your practice. This will help in assigning resources to efficiently handle them.

Categorizing Denials: The system should be able to categorize denials by type. This would include enrollment, authorization, coverage, medical necessity, medical justification, etc. The ability to standardize into category themes across payers will give your practice another data set to analyze in the effort to minimize denials.

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