3 steps to keeping accounts receivable in order

Practice Pointers. By Karen S. Schechter, AMNews contributor. July 18, 2005.

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Question: My associate and I are starting a new private urology practice after being employees of a large practice for five years.

One of the billers from the practice will be coming with us so that we can set up an in-house billing department.

We plan on hiring at least one person to perform the accounts receivable management function at our new practice.

At this time we do not have a business manager and are uncertain about to how to organize the accounts receivable process and prioritize the tasks. Can you provide any guidance?

Answer: There are three main areas associated with accounts receivable management. They are prioritized in this order: insurance follow-up, patient follow-up and credit balance management.

How one organizes the staff to address these areas depends on the practice's patient volume, payer mix, and number and qualifications of staff assigned to the accounts receivable management function.

The following describes each of the areas and gives guidance on how to prioritize the work within each one.

The first area, insurance follow-up, begins shortly after the claim has been transmitted to the insurance company. There are two categories: claims that have been denied or paid incorrectly, and open claims (claims for which no explanation of benefits has been received).

The first category, denied or incorrectly paid claims, must be worked on daily. The follow-up should be prioritized by the date the EOB was received and by payer.