Work Strategies: 3 Things to Consider for Insurance A/R Claim Follow-Up

How well do you know your current A/R inventory? When creating actionable work strategies to maximize payer reimbursements for insurance accounts receivable claim follow up flexibility is imperative. Not knowing exactly what the mix of A/R you currently have on hand can lead to immediate and long term complications and significantly decrease cash performance.It’s much easier to stay on top of A/R claim follow-up from the outset than to retroactively assess what A/R didn’t get worked and why. It may not be easy to implement a dynamic work strategy and stick to it, but it’s imperative to your organization’s cash goals.

Here are three components of creating a successful work strategy:

Goals

First, set short term and long term business goals. What type of project do you have to work? For example, if you’re going through a system conversion process within your organization you might have a big liquidation project that needs to be worked in a short amount of time. The type of project will highly influence your goals.

Perhaps an immediate goal of your organization is to hit a cash threshold by the close of the fiscal year or to get all of the old A/R resolved so it’s not on your books. Another common goal is to work through your inventory and identify trends so process improvements can be made at the front end to increase your clean claim rate. Sometimes there is a clear issue that needs immediate attention, for instance, you might have a large number of coding rejections to work through. Setting goals will help you devise a work strategy and highlight where additional resources are needed.

Double exposure of businessman hand working with new modern computer and business strategy as concept.jpeg

Strategy

Once you have a good idea of what your organizational goals are, the next step is to look at your inventory and analyze what you’re doing right and what is driving the highest cash performance. There’s much more to cash collection than simply working those high dollar claims. On the flip side, you must also uncover errors that are leaking revenue. There could be gaps on the front end of your revenue cycle or previously undiscovered issues with payer contracts and underpayments. Devise a plan to stop that revenue leakage as soon as possible. A good starting point is to analyze the most common and highest volume of claim denials.

A work strategy is never static, you need a nimble plan to follow the money. Account inventory should be reconciled and strategized at least monthly to figure out the best touch and right approach. You may not need to make a change that often, but always ask: how well is the current strategy working? Look for the introduction of new factors that could complicate the road to achieving your goals.

Execution

If your goals are set and you’ve identified common issues in your practice and what is going well, it’s time to get down to business and figure out exactly how you are going to attack your A/R.

Organizing your team of A/R follow up staff allows them to become very familiar with their payer and the specific set of rules and issues unique to that payer, like timely filing guidelines.

If you devise a weekly work strategy, each day your staff will be working a different subset of your A/R. Work strategies are never typical, but may include the following elements in order to achieve the balance of working new inventory in a timely manner, while not missing older inventory that requires follow up and additional touches to move it towards resolution:

Claims that have already been touched, but not resolved
New inventory and untouched claims
High dollar down
Claim edits and clearinghouse rejections
Secondary payers
A specific denial type
Work claims close to timely filing deadlines
Small dollar older claims

Take into consideration your staff’s productivity and quality goals to further adjust the work strategy and allow for efficiency in your process to drive success in your organization.

The Bottom Line

A finely tuned and ever-evolving work strategy creates a best practice standard for working accounts and collecting cash in the most efficient way possible because your A/R is always changing. Do your pre-work to have a full understanding of the type of project you’re resolving, and define clear goals. Allow your strategy to be flexible and recognize quickly what is working and what is not so you can adjust accordingly.