Insurance Payment and Account Receivables Analysis
In performing the revenue cycle management (RCM) for our customers, MedUSA makes recommendations on process, workflow and claims changes to maximize the Practice’s financial performance. We do so by leveraging our 27 years of experience providing Revenue Cycle Management services for Medical Practices across the country. Over time, it was only natural for us to offer the same expertise to organizations that were performing the billing in-house, but needed the benefits of our financial acumen. This need, and repeated requests from various Physicians gave rise to our Consulting Practice.
Our goal in performing the Payment and Account Receivables (AR) Analysis is to identify patterns and/or high incidence of unpaid CPT codes or insurance companies with slow / no pay. Insurance and Patient Report evaluations and review of Notes, Claims submitted, EOBs, Statements and other billing related artifacts allows us to identify issues causing denials and a sustained or growing AR. Based on industry best practices and our experience in eliminating such financial pitfalls, our consulting team makes recommendations that will assist in improving office processes, reducing denials, and maximizing first response payments.
Information Required From Practice
- YEAR TO DATE (current and previous) totals of Frequency, Charges, Payments and Adjustments by Practice, by Provider (if multiple), by Department, by Location, by Payer.
- ACCOUNTS RECEIVABLE REPORTS (up to 365 days)
- Primary Insurance AR Summary by Aged Days preferably by Insurance Plan, by Department, by Provider (if multiple) and by Location (if multiple)
- Primary Insurance AR Detailed by Responsible Party. Aged Totals by Carrier and Aged Patient Totals under each carrier. Detail should include CPT, Modifiers, Quantity, DOS, First Billed, Follow-up date, Provider, Department, Location (if multiple), Charged Amount, Paid/Adjustment, Balance
- Patient AR Summary Aged Days by Financial Class, and by Location (if multiple).
- Patient AR Detail by Responsible Party. Aged Totals by Patient Detail should include CPT, Modifiers, DOS, First Billed, Provider, Department, Location, Charged Amount, Paid/Adjustment, Balance
- List of Procedures including CPT, description and standard practice fees
PLEASE NOTE: Preferred report format: Excel.
Additional Information Requested as Needed:
- Notes / Denials / EOBs will be requested for further clarification of specific patterns identified
- Carrier Agreements / Registrations may be requested specific to carriers with poor history of payment
After the above information is received, the MedUSA team will review the details, and schedule calls as required with the Practice’s team for clarifications and follow-up.
On-site meetings and or conference calls will be scheduled as needed to understand the billing process, workflow, the Practice’s perception of issues and bottlenecks. The calls and meeting will include, but may not be limited to, the front office (scheduling, reception, check-in), the billing manager, billing staff and the physicians.
Upon completion of the evaluation process, MedUSA will provide a written summary of the findings, including:
1.The issues causing reduced / delayed reimbursements
3.Best Practices to implement the recommendations
MedUSA staff can assist in implementing the recommendations at an additional cost.