Backend Revenue Cycle
Accounting for Payment Received, following up on claims delayed or denied, and being in compliance by accounting for excess payments (credit balances) is the focus of the back-end revenue cycle.
Back-end Revenue Cycle
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Ascribe’s Back-end Revenue Cycle Management involves collection and management of revenue from the back office. The cycle starts after the provider has conducted a patient visit and we have performed clinical documentation and coding responsibilities, and submitted the claim. Our team includes experienced payment posters and accounts receivable and denial management professionals,
A/R and Denial Management
A/R Follow-up calls
Denials - issue identification, appeals and follow-up
Continuous process improvement by providing feedback to the front-end processes
Credit Balance
Compliant processing of credit balances
Patient and Insurance credit balance processing
Payment Posting Services
Improve accuracy, improve front-end and back-end collections, and make process changes to improve your revenue cycle.
Highlights of Ascribe Healthcare’s Payment Posting Services
Ascribe Healthcare Solutions offers market-leading SLAs for accurate and timely payment posting services. Our well-defined payment posting process not only ensures efficient processing but also helps you identify opportunities to increase revenue by watching for trends of payments, and denials. Our services include the following components to make your billing process more efficient and lead to an improvement in revenue.
EOB and ERA posting and reconcilement – We meticulously capture the data from EOBs, lockboxes, and ERAs, ensuring a high degree of accuracy of payments posted on the revenue cycle system.
Denial prevention - We examine each denial to identify issues such as denial for medical necessity, non-covered services and prior authorization to provide constructive feedback to the entire chain of physicians, front office staff, billers and coders to avoid such errors in the billing cycle and improve reimbursements.
Denials posting and reworking - We rework each denial and resubmit the claim to responsible payers in an efficient manner to enable recovery of as much reimbursement due as possible
Patient responsibility for Payment - Patient dues are identified and the balances are moved to patient responsibility to ensure faster patient billing and initiation of the patient collections cycle.
Write-offs and adjustments – We process write-offs, adjustments and look into contractual adjustments and passing them to management when issues are identified. We work with the provider’s office to help develop the write-offs and adjustments policies to ensure that the accounts receivable data shows the right view to the management. Often, practices with ineffective write-off and adjustment policies have erroneously inflated A/R views and such situations can be avoided through effective policies
In-person collection issues – Front offices of the provider’s office make mistakes with the collection of deductibles and/or copayments when processing insurance remittances and this has a major impact on the overall billing process. Through Ascribe’s best practices in identifying these issues, the front-office gets constant feedback on missed opportunities which leads to behavioral corrections at the front-office.
Better cash flow, better collections, faster identification of issues and resolution of these issues across the chain, these are some of the value propositions that Ascribe’s payment posting services offer. Secondary billing effectiveness and initiation of patient collections processes ensure that the entire medical billing process runs effectively.
Accounts Receivable Follow-up and Denial Management
Improve collections with experienced A/R follow and denial management professionals from Ascribe Healthcare.
Accounts Receivable follow-up process
Accounts Receivable follow-up process involves the pursuit of an outstanding claim to ensure that the healthcare provider receives payments for the services rendered. This requires the investigation of where the claim is in the cycle, get the correct status of the claim and taking steps to ensure that the claim is adjudicated and paid.
Scenarios post submission of Claims
Post submission of claims to the healthcare payer, one of the four events could occur:
Claimed amounts are paid appropriately. This is the ideal case for the healthcare providers that they receive the expected level of reimbursement.
Incorrectly paid claims. Incorrect payments could be on account of over-payments or under-payments. Over-payments need to be repaid to the insurance companies (credit balances) and underpaid claims require an analysis of the cause of the underpayment and appeal back to the payer to adjudicate it correctly.
Denied Claims. Claim denials can happen on account of a variety of cases and hence the denial management staff should determine where the error has occurred, fix the error and appeal the claim.
Unpaid Claims. Claims may remain unpaid on account of incorrect insurance information of the patient, delays at the payer end (lost claims), inaccurate patient information, or claim being held by the payer. These open claims should be actively pursued, appropriate status obtained, and resolution of the issue to get the claim back into the adjudication cycle.
Ascribe Healthcare brings energetic team members who have the knowledge of the reimbursement processes, exercise highly diligent and streamlined process to ensure that our clients are able to maximize reimbursement.
Our expertise and best practices in Accounts Receivable Follow-up
We help our clients recover more money through a structured process that involves:
Sorting of Claims to prioritize Accounts Receivable follow-up
Sort by balance due(highest to lowest) and clubbing them into buckets such as $3,000+, $2,000–2,999, $1000–1,999, $500–999, $100–499, $50–99, $10–49
Sorting by Ageing buckets – 120+ days, 90-119, 60-89, 30-59, and current
Sort by payer type
Sort by date of service and date of claims submitted
Ensure Timely Account Follow-Up and strive to keep as many accounts current as possible
We follow-up on all open claims to ensure that each claim is addressed
We organize our teams by Payer to help them understand and develop payer-specific follow-up strategies and build relationships with the payer team
Routinely, we initiate feedback on denial trends to the front end to prevent denials from occurring
With more and more payers providing claims status online, we improve physician adoption of online services by creating logins for the physician and utilizing it both for A/R status as well as for eligibility verification, where available.
Denial Management Services
Healthcare Providers are getting impacted on account of falling reimbursements rates and shift to value-based care. A strong denial management process can help providers recover more money and shift focus to preventing denials. Each claim denial is posted on the patient’s account in the revenue cycle system. Errors are reported to the front office and billing staff so that the errors are not repeated.
Reasons for Claim Denials
We understand all major sources for claim denials:
Errors in the Patient Registration process – capturing of patient’s information or payer information
The insurance verification process has not been performed or prior authorization has not been obtained
Errors in entering charges for services performed
Referrals or prior authorization not performed
Duplicate claims
Medical necessity of the procedure not ascertained or undue medical procedures performed
Errors in medical coding – unbundling, use of modifiers, correct coding edits, etc.
Denial Analytics
We track and measure the following data for claim denials:
% of claims denied on initial submission
Number of denials and average dollar value of claims
Top 10 reasons for claims denied
% of denied claims that are re-worked
The time lag between the date of denial and date of the appeal
% of claims reworked and got paid
The dollar value of denials reworked and got paid
Structured process for reworking denied claims and shifting focus to denial prevention
We track all claims denied and rework the same based on the issue. We review the top 10 denials for major payers and follow a structured process for reworking all claim denials:
We develop appeal letter Templates for all major denials
Identify the denials by the payer and re-submit the claims along with medical documentation required such as office notes, operative reports, lab reports, discharge reports, etc.
For denials of medical necessity, we examine the treatment protocols, understand the payer’s policy statements, understand the specific cases to examine medical necessity, taking the help of our medical coding team to substantiate the claim of medical necessity, if and as appropriate.
We cross-train our staff on payer-specific denial protocols and specific denial codes
Finally, we use denial data to reorganize and make changes to the front-end, coding, charge entry, and claims submission processes
We track and publish denial data every month to ensure that the focus shifts from denial management to denial prevention
Credit Balance Management Services
We help you be compliant through timely credit balance management and refund .
As a practice, we regularly research and resolve any outstanding credit balances. As agreed with ur clients, we generate a credit balance report periodically, correct any errors in payment posting, and research each instance of credit balance to ensure appropriate refunds are sent to the patient and/or payer. Many payers, including Medicare and Medicaid require healthcare providers to repay overpayments within a specified time period.