All practice management systems produce an aged accounts receivable report, and if a practice has more than one department, the software developers have learned that the doctors want a report by “their” department. While that is a helpful sort of the data, it is not as helpful as an aging report that is sorted by payer. Many effective revenue cycle teams are organized with individuals assigned to follow up on unpaid claims from specific payers. At one time or another all payers will experience difficulties with claims processing, whether as a result of practice claims data or the payer processing systems. Knowing that a department has a high volume of claims outstanding is not as useful as knowing which payer to call to get traction on payment. And when one person is accountable for a payer performance it gets personal.
The biggest take away here is that aging should be reported based on how the billing responsibilities are divided. If they are assigned by payer, run the report by payer. Depending on how your practice is organized and how your revenue cycle department functions, reports sorted by specialty, then by payer, this may highlight very useful information. You will likely observe that each payer has an average turnaround time by specialty or by CPT code. If this is indeed the case, these reports will help you to identify what is causing a payer to take longer to process claims or have stopped processing altogether. If you are finding changes in payer adjudication and payment; and a corresponding increase in denials, sorting and reviewing a denial report may lead to any changes in the clinic that may be impacting the same - changes within clinical staff, provider, biller, coders or their work processes may need scrutiny.
And, let’s not overlook the exponential growth in patients covered by High Deductible Health Plans. Separating the self-pay aging from the insurance aging allows staff to take different approaches to collecting outstanding balances.
Conducting a regular analysis of your aging reports is crucial after significant operational changes. For example, such as an EMR transition, you may find that non-compliance or at least, less rigid compliance with self-pay and related policies, may cause Self Pay A/R to rise higher than your targets. Understanding these reports and changes, gives you the opportunity to adjust and re-evaluate how you are currently handling the self-pay balances versus how you should be. Whether patients have insurance or not, these are all still self-pay balances once insurance has processed their portion.
Please contact us if help is needed navigating the ins-and-outs of your practice's revenue cycle.