Accounts Receivable (AR) Management

MedNexa Health - Service - Accounts Receivable (AR) Management

Effective follow-up and collections to reduce aging AR.

Outstanding accounts receivable represent money you’ve earned but haven’t collected. The longer claims sit unpaid, the less likely you are to collect. Our AR management team systematically works aging claims, follows up persistently with payers, resolves payment delays, and accelerates your practice’s cash flow.

What’s Included:

AR Analysis & Prioritization:

  • Daily AR aging report review (0-30, 31-60, 61-90, 90+ days)
  • High-dollar claim prioritization (Pareto principle: 80/20 rule)
  • Work queue organization by age, payer, and amount
  • Priority focus on claims approaching timely filing deadlines
  • Payer-specific AR concentration analysis
  • Provider-specific AR review
  • Service-specific AR patterns

Insurance AR Follow-Up:

Claim Status Investigation:

  • Daily claim status inquiries for unpaid claims over 30 days
  • Electronic claim status checks through clearinghouses
  • Payer portal claim status verification
  • Direct phone contact with payer claims departments
  • Tracking number and status code documentation
  • Reference number recording for all payer contacts
  • Detailed notes on every follow-up attempt

Payment Delay Resolution:

  • Identification of claims in pending status
  • Additional documentation submission when requested
  • Corrected claim submission for payer processing errors
  • Expedited payment requests for long-pending claims
  • Escalation to supervisors for claims exceeding normal timeframes
  • Suspense file investigation and resolution
  • Lost claim resubmission

Payer Communication:

  • Regular contact schedule (every 10-14 days for claims >30 days)
  • Direct phone calls to claims examiners
  • Email follow-up for documentation requests
  • Fax correspondence for urgent matters
  • Portal messaging for electronic communication
  • Escalation calls to managers for problematic claims
  • Documentation of every conversation (date, time, rep name, outcome)

Underpayment Investigation:

  • Payment variance analysis (expected vs. actual payment)
  • Contract rate verification for correct reimbursement
  • Incorrect payment appeals and reconsiderations
  • Bundling/unbundling dispute resolution
  • Modifier review for proper payment
  • Duplicate payment identification and resolution
  • Overpayment refund processing

Coordination of Benefits:

  • Primary insurance payment confirmation before secondary billing
  • Secondary insurance claim submission with primary EOB
  • Tertiary insurance billing when applicable
  • COB error resolution and correction
  • Medicare primary/secondary payer determination
  • Birthday rule application verification

Timely Filing Management:

  • Proactive filing of claims approaching deadlines
  • Timely filing extension requests when warranted
  • Documentation of delays beyond provider control
  • Good cause timely filing appeals
  • Proof of original claim submission for denied claims

Secondary & Tertiary Billing:

  • Automatic secondary insurance billing after primary payment
  • Patient-specific COB determination
  • Secondary claim preparation with primary EOB attachment
  • Medicare supplemental insurance billing
  • Tertiary insurance identification and billing

Patient AR Management:

Patient Balance Billing:

  • Automated monthly statement generation
  • Clear, itemized statement format
  • Multiple statement cycles (30, 60, 90 days)
  • Escalating message intensity for aging balances
  • Payment options clearly communicated
  • Online payment portal information
  • Phone and mail payment options

Patient Contact & Collections:

  • Friendly courtesy call for first statement
  • Payment reminder calls at 30, 60, and 90 days
  • Payment plan options for large balances ($100-500+)
  • Financial hardship program information
  • Charity care and sliding fee scale options
  • Payment arrangement setup and monitoring
  • Broken payment plan follow-up

Payment Plans:

  • Flexible payment plan options based on balance size
  • Interest-free plans for qualified patients
  • Automatic recurring payment setup (credit card/ACH)
  • Payment plan agreement documentation
  • Monthly payment reminder notifications
  • Default payment plan follow-up and resolution

Collection Agency Management:

  • Bad debt identification criteria (typically 120+ days)
  • Collection agency selection and relationship management
  • Account placement with detailed documentation
  • Collection agency performance monitoring
  • Patient dispute resolution before agency placement
  • Final collection efforts before write-off

Self-Pay & Uninsured Patient Management:

  • Upfront payment discount programs
  • Payment plan options at time of service
  • Financial screening and assistance application
  • Charity care program enrollment
  • Prompt pay discounts for immediate payment
  • Payment expectation communication before service

Small Balance Management:

  • Small balance write-off policies ($5-25 depending on practice)
  • Cost-benefit analysis of collection efforts
  • Automated small balance processing
  • Statement suppression for minimal balances

Refund Processing:

  • Patient overpayment identification and resolution
  • Insurance overpayment refund requests
  • Timely refund processing (typically within 30 days)
  • Refund application to outstanding balances when appropriate
  • Credit balance monitoring and management
  • Refund check processing and mailing

AR Reporting & Analytics:

  • Daily AR aging reports by payer and provider
  • Days in AR calculation and trending
  • Collection rate percentage tracking
  • AR over 90/120 days monitoring
  • Payer-specific AR performance
  • Provider-specific AR patterns
  • Bad debt and write-off reporting
  • Net collection rate analysis
  • Gross collection rate tracking

Technology & Automation:

  • Automated work queues for efficient prioritization
  • Electronic claim status batch processing
  • Auto-posting of ERA payments
  • Automated statement generation and mailing
  • Online patient payment portal
  • Text message payment reminders
  • Email statement delivery options
  • Predictive analytics for collection likelihood

Performance Metrics:

  • Target days in AR: <30-35 days
  • Collection rate goal: >95%
  • AR over 90 days: <15% of total AR
  • AR over 120 days: <5% of total AR
  • Patient collection rate: >90%
  • Bad debt percentage: <3% of charges
  • Write-off percentage: <2% of charges

Benefits:

  • Reduce days in AR by 30-50%
  • Increase collection rates by 10-15%
  • Accelerate cash flow for better financial stability
  • Minimize bad debt and write-offs
  • Free staff from time-consuming follow-up calls
  • Improve patient satisfaction with clear billing communication
  • Ensure you collect every dollar you’ve earned
  • Maintain positive payer relationships through professional follow-up

Follow-Up Frequency: Claims over 30 days old receive follow-up every 10-14 days until resolved