We believe that effective Insurance Follow-up and AR (Account Receivables) Management are the most important areas to ensure optimum revenue recovery, accelerate revenues, and increase cash flow. Lost revenue due to denials averages between 6% and 10% of net revenue nationwide. We have a proven track record of enhancing the financial health of our clients.
Consider the following facts
1. 14% of all claims submitted to payers are denied and have to be resubmitted, appealed, or written off by Providers.
2. 50% of denied claims are never re-filed.
3. 90% of denials are preventable.
4. 50-70% of denied claims are recoverable.
This can cost your clinic or practice thousands of dollars every year. Aside from the direct impact from the loss of revenue, there’s an additional impact on resources because of the expense associated with reprocessing denied claims.
Why do I have to face so many claim denials?
We will use Medicare as an example but this could apply to Medicaid or other third-party insurance companies as well. Medicare claims get denied mainly for the following reasons.
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Incorrect or missing ICD-10 diagnoses
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Incorrect or missing CPT-4 modifiers
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Duplicate claim
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Additional information needed to process the claim
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Claim billed amount incorrect
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Incorrect or missing CPT procedure code
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Physician's name and/or UPIN missing or incorrect
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Incorrect or missing place of service code.
Outstanding claims and delayed collections place added administrative strain on a hospital or physician's practice. On one hand, insurance companies often deny claims or refuse to pay them. On the other hand, federal regulations have become increasingly more stringent in the USA. Recently the federal Centers for Medicare & Medicaid Services announced that they would reduce the time physicians are given to file an appeal against a claim denial - from six months to 120 days. This increases the pressure on the staff at your healthcare practice to follow up on denied or appealed claims.
Why do I have to face so many claim denials?
Simplyfyd Care helps you avoid payment delays from Medicare as well as from other third-party insurance payers by following these steps:
1. We review all claims before submission
This cuts down significantly on the error rate. We spend time on reviews at the front end, rather than spend a longer time later to deal with each denial.
2. We maintain a billing and coding claims review log
We track the trends for each healthcare BPO provider, based on the remittance advice from Medicare as well as the EOBs (Explanations of Benefits) from all third-party payers. We monitor and evaluate these trends to find ways to fix the problems causing the denials and rejections for your practice.
3. We do a monthly billing review
All the staff involved in the accounts receivable function, i.e., those who perform tasks such as data entry, coding and documentation, billing and payment posting, analyzing denials, and down coding get together once a month to review
ACCOUNTS RECEIVABLE FOLLOW-UP SERVICES
You must have witnessed a steady growth in the healthcare charges levied on your patients. But did you wonder why you aren't encountering similar growth in your healthcare organization's net cash influx? The reason for this lies in your accounts receivable process. A complete claims reimbursement requires accurate charge capture and clean claims. And if somehow claims get rejected, then, managing the receivables for unclean claims becomes a daunting task.
At Simplyfyd Care, we ensure a validated AR follow-up process. We have highly trained & and competent AR experts who leverage advanced and robust tools to accurately examine, correct, appeal, and/or re-file the claims. Our accounts receivable follow-up service focuses on the problems that hinder the collection efforts in the first place. We have a dedicated team of medical billing collection experts. Some of the services we offer include -
Our experts can help your organization keep track of all the pending claims, investigate denials, follow up on collections, track balances, and pursue any other due payments. Our services will help you reduce the number of AR days and improve your healthcare organization's cash flow.
Our expert team has the required skills and experience to follow up with the insurance companies through their website and Internet payer portals. They can quickly check the status of the unpaid claims.
We have the required talents, infrastructure, and validated processes to identify the factors leading to non-payment of dues. We help you recover debts in a timely fashion by committing to rejecting claim applications.
We can help you create different types of financial reports. We also assist you in differentiating between the collectibles and non-collectibles identify co-insurance and bill them accordingly. From monthly to quarterly to yearly, we can help you with all the required financial report creation