ACCOUNTS RECEIVABLE

Accounts Receivable

Why Choose Rely On Us?

  Having understood the physician pain, Rely On Us as a Revenue Cycle Management (RCM)   company primarily focuses on improving the physician cash flow, reduce rejections and follow   up with insurance / patients for prompt payments.

Our proven RCM strategies enhances revenue optimization and elevates the practice operational performance; more importantly help physician groups to address their day to day medical billing challenges and other revenue cycle management requirements.

As soon as we are on board, we quickly identify global issues and other process gaps to improve the Physicians cash flow / first pass rate & reduce rejections

Predominantly Rely On Us uses KPI metrics as a managing and checking point to improve the Net Collection Ratio of the Physician practice.

Best RCM techniques are deployed to address delinquent accounts to completion especially the old or aged AR.

Periodical reviews and management of bad debt accounts results in collection of payments.

Physician groups are always under tremendous stress to improve the quality of patient care and to reduce the healthcare cost.



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Our path to success

Charges are entered and submitted within a TAT of 48 hours from the DOS

Clearing house rejections are worked to resolution within a TAT of 24 hours

Prior to the claim submission, Eligibility verification will be performed to avoid eligibility denials

Aggressive follow up on aged AR claims.

For each specialty, MGMA standards are used for guidance and followed upon

Three levels of quality checks are implemented to ensure that set quality target percentage is achieved

Refresher training sessions to all the staff on Insurance information’s and updates.

Weekly, Monthly & Quarterly dashboards on the agreed KPI’s are published

Reconciliation Dashboard - Services Performed Vs Charges Entered Vs Charges Submitted to the insurance Vs Charges Accepted by the insurance

Submission of a clean claim to the payer is always the priority

Accounts Receivable Follow-up Services

Rely On Us works on AR by Age Trail Balance (ATB) by Insurance wise, thereby assisting physicians in obtaining faster payments, and lesser AR days

Primary goal of Rely On Us is to ensure that Insurance AR days is always lesser than 40 days.

Please refer the below AR work Flow

AR is analyzed based on the ATB reports and appropriate work-files are created based on Rejection codes, Dollar threshold, Payer wise, Service Date Wise, No Activity vs Rejection, Provider, Location etc., and allotted to the team members.

AR Work files will be worked to completion.

Status of the claim will be assigned to each account in the work file post working. In addition to the status, an action code will be assigned indicating the action taken on the claim

At the end of every week, detailed report will be run to identify the trends and gaps along with the status of the physician account

In short, AR Team works the account to completion in the following 3 ways namely: -

.

Appealing or resubmission of claims for payments

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Flipping the balance to the patient level based on the AR scenario

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Adjusting the claims

Historical rejection data is compiled and used during refresher training program

RELY ON US offers the following different types of Accounts Receivable Scope of Work

INSURANCE ACCOUNTS RECEIVABLE SCOPE OF WORK
TYPE CATEGORY SCOPE OF WORK CRITICALITY
Focused Outsourced Solutions Credit Balance Resolving negative Patient Account Balances It is mandatory for the provider to refund any identified excess payments received from insurance or patients provided that the insurance refund request is within the prescribed state time limit
Unidentified Payments Applying payments to correct invoices by requesting copies of EOB's, Cancelled Check from Insurance To reflect and follow up on true outstanding A/R for payments
Bad Debt Recovery Reworking of invoices which were written off incorrectly for potential payments To improve Gross Collection Rate
Underpayment Recovery Identification of Underpayment patient accounts and following up with insurance for additional payments To improve Gross Collection Rate
Denial Management / Referred AR follow up - Resubmission and appealing of invoices which were denied incorrectly To improve Gross Collection Rate
Aged A/R or Old AR Inventory - Strategic addressing of No Response / Rejection accounts receivables of 90+, 120+,180+,365+ AR towards resolution To improve Gross Collection Rate


Self-Pay A / R – Key Methodologies

Collection methodologies do vary by client depending on their policies and procedures

All accounts receive a series of phone calls and letters in addition to their statement series (Typically, each patient will receive two phone attempts and three letter attempts)

Delinquent accounts are identified and moved to collections.

Prioritization of accounts into various work queues

The account queues are sorted by balances, so special emphasis is always accorded to the higher patient balance accounts.

Our systematic approach ensures that all avenues of reimbursement from government eligibility program such as Medicaid, Charity Care and/or Financial Hardship are assessed and explored.


Remarkable features of A/R Follow-Up Services

Lesser A/R Days

Faster insurance payments

Increase in First Pass Ratio

Increase in NCR

Underpayment Follow Up

Skip Tracing on high $ patient accounts

Reduced eligibility rejections

Denial Management & Aged AR follow up

Appeals and resubmission of claims wherever it is appropriate

Business Intelligence Reporting



Differentiator

We help you achieve your financial goals

The chart below illustrates how RELY ON US's accounts receivable solutions increases your revenue, reduce your write-offs and improve revenue:
Issues You Face Impact on Your Business How RELY ON US 's Solutions Benefit You
Insurance Follow Up

* Lack of proper follow up

* Regular changes in Managed care contracts.

* Ever changing re-imbursement pattern

* Low revenue

* High bad debt

* Increase in AR aging

* Underpayments

* Improved workflow process and increased productivity using In House AR Work Flow Tool

* Identify global trends

* Appeal claims

* Reduce aged AR

* Encourage electronic billing and resolve timely filing

* Target Payor specific denials



Key Metrics and Objectives


Denial Management

Assist to ensure an overall Denial Rate (% of Gross Revenue) <= 7%

Underpayments additional collection rate >= 75%

Appealed denials overturned rate 40-60%


A/R Management

Percentage of Insurance A/R above 120 days at 12-18%

Assist to ensure Insurance A/R Days maintained at 35-45

Insurance Net Collection rate retained at 94-97%


Sample Reporting Template



KPI: “Key Performance Indicators” helps us to review the performance of the process through various measures/metrics

Measures: Charges, Payments, Contractual Adjustments, Write Offs.

Metrics: AR Days, GCR, NCR, Self-Pay AR (%)