Client Background
The client is a well-known healthcare organization based in the USA. They have an internal EDI team that 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 smooth functioning in the future. They share the reports on a daily, weekly, and monthly basis. They also share and deploy any kind of edit that is needed in the software to trigger any kind of warning.
Client Challenges
- The 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 filing limits.
- There was no proper documentation and escalation for these claims; hence, it was getting difficult to follow up with insurance.
Our Solutions
- Clearer Prioritization: Our AR experts implemented a strategy to categorize accounts receivable (AR) based on their age buckets. This allowed us to prioritize collections by focusing on the most time-sensitive and critical cases first.
- Data-Driven Insights: By analyzing trends and patterns, our team could identify bulk denial scenarios and develop customized solutions to improve collection rates. This proactive approach enabled more effective cash recovery, even in challenging situations.
- Improved Training & Processes: Comprehensive training sessions were conducted to enhance documentation practices and escalation protocols. This ensured that each follow-up was well-informed and corrective actions were taken promptly, reducing errors and improving communication with payers.
Our Results
- Effective Denial Management: Denials are now systematically categorized, enabling the client to implement edits that address common issues before they reach the billing stage. This front-end approach has significantly reduced the volume of denials.
- Standardized Processes: Instructions and guidelines have been documented and are now readily available for future reference. This reduces the need for unnecessary follow-ups and appeals, streamlining the AR process.
- Improved Financial Health: With optimized AR processes, our client has experienced a healthier cash flow, allowing them to focus on core operations and maintain a more efficient, stress-free working environment.
By addressing these key areas, the Outsource AR team has empowered the client to enhance their operational efficiency, reduce administrative burden, and build a more resilient financial framework.