The client is a well-known healthcare organization. They have an internal EDI team which works with the insurance companies and clearinghouses to send claims and reviews the acceptance report to identify and correct any kind of submission or clerical errors. They ensure that the registration issues are solved within 24 hours and any kind of errors are measured in terms of percentage and shared with hospitals for the smooth functioning in the future. They share the reports on a daily/weekly/monthly basis. They also share and deploy any kind of edit that is needed in the software to trigger any kind of warning.
They believe that good data analysis helps to save a lot of time and money. Before any call is made to the insurance company, they perform a complete analysis of the inventory and share the priority plan with their client for approval. The client's top priority is old AR based on collectible and non-collectible denials, followed by high dollars in descending order, and finally new AR and non-collectible denials. Each priority is presented in the form of a report to identify the pattern of denials. They also share the complete AR study report with their clients monthly.
Problems Faced by the Client
Accounts receivable is one of the key areas in revenue cycle management which helps to build a better cash flow and in collecting the outstanding AR. Client was looking for reliable accounts receivable service provider to help them out with their problems. Some of the problems they were facing include -
Denials were handled without any kind of proper analysis
No preventive measures were being carried out by them
There was no proper documentation and escalation done for these AR cases
We faced a few challenges when client outsourced their AR processes to us. Some of those challenges include -
Majority of the AR volumes would accumulate in the old AR and would get difficult to handle
Though the client knows how to handle the denials and what actions to take to resolve them, the claims were running into timely filling limits
There was no proper documentation and escalation for these claims hence it was getting difficult to follow-up with insurance
Keeping in mind the client's challenges, problems, and their specific requirements, the following solution was devised by our expert team at Flatworld Solutions -
It was decided that the AR would be split based on the age bucket. This would help us to prioritize the AR based on the severity
Trends and patterns would be identified to help collect money in the case of bulk denials
There would be proper training provided for documentation and escalation. This would help in consecutive follow-ups to understand them and take the required corrective measures without failure
Healthcare and finance experts at Flatworld ensured that all the project processes run smoothly according to the plan. Some of the key results achieved during this project include -
The denials at the client's end can now be categorized and the edits can be deployed to arrest most of the denials in the front-end or before entering the charges
Now instructions can be prepared and kept for future references to avoid any kind of unnecessary follow-up or appeal
Our services also helped our client to improve their cash flow and practice a healthy working style
Choose Us for Efficient Healthcare Accounts Receivable Services
Flatworld Solutions has been providing top-quality healthcare accounts receivable services and a plethora of other healthcare BPO services to clients around the world. We ensure that the healthcare provider is paid on time for every claim and experiences an increase in revenue. Our cost-effective services will make sure that your company's cash flow is improved and you get a healthy flow of income every month. Our team of healthcare experts is trained to handle CPT and HCPCS coding as well as ICD coding with ease. We follow strict ISO standard guidelines which and ensure that all the results we deliver are of high quality and highly accurate.
If you have a similar requirement and are looking for a reliable and cost-effective healthcare accounts receivable service provider, then you have come to the right place. Get in touch with us today!