Podcast
Questions and Answers
What is important for improving revenue cycle efficiency?
What is important for improving revenue cycle efficiency?
What is the preferred method for submitting claims?
What is the preferred method for submitting claims?
Electronic claims
Collaborating with an experienced Clearing House can improve claims processing.
Collaborating with an experienced Clearing House can improve claims processing.
True
To maintain cash flow, monitor claim rejections and __________ corrected claims promptly.
To maintain cash flow, monitor claim rejections and __________ corrected claims promptly.
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Why should AR reports be reviewed weekly?
Why should AR reports be reviewed weekly?
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What should be done with remittances upon receipt?
What should be done with remittances upon receipt?
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Large clinics tend to have a lower Accounts Receivable (AR) due to the volume of services.
Large clinics tend to have a lower Accounts Receivable (AR) due to the volume of services.
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Match the following claim submission methods with their descriptions:
Match the following claim submission methods with their descriptions:
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Which of the following services allow manual claim submissions electronically as a backup?
Which of the following services allow manual claim submissions electronically as a backup?
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What is the preferred method of claim submissions?
What is the preferred method of claim submissions?
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Name an example of a Clearing House for efficient claims processing.
Name an example of a Clearing House for efficient claims processing.
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It is beneficial to send claims daily to prevent backlog.
It is beneficial to send claims daily to prevent backlog.
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What should be monitored regularly to ensure accurate Accounts Receivable?
What should be monitored regularly to ensure accurate Accounts Receivable?
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To maintain low Accounts Receivable levels, practices should constantly manage claims and monitor ______.
To maintain low Accounts Receivable levels, practices should constantly manage claims and monitor ______.
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When should remittances ideally be posted?
When should remittances ideally be posted?
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What AR columns should be analyzed to identify trends?
What AR columns should be analyzed to identify trends?
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Regularly informing staff about ongoing issues can help in achieving clean claim submissions.
Regularly informing staff about ongoing issues can help in achieving clean claim submissions.
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Which of the following statements is true regarding small and large practices?
Which of the following statements is true regarding small and large practices?
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Study Notes
Revenue Cycle Management
- Importance of maintaining low Accounts Receivable (AR) to improve revenue cycle efficiency.
- Begin with generating an insurance AR report to establish a baseline for analysis.
- Analyze the report for problematic insurances and low payers; ensure the accuracy of payments posted.
Claim Filing Processes
- Electronic claims are preferred over paper claims; many insurers accept only electronic submissions.
- Collaborate with an experienced Clearing House for efficient claims processing; Gateway evi is an example.
- Utilize electronic remittances (ERAs) to receive remittance advices in a centralized location.
Secondary Claims Submission
- Consider using Clearing Houses with online secondary submission capabilities to save time and costs.
- EDI services with alternative Clearing Houses, like availity or identity, allow manual claim submissions electronically as a backup.
Daily Management Tasks
- Send claims daily to prevent backlog.
- Monitor claim rejections and resubmit corrected claims promptly to maintain cash flow.
- Retrieve and apply insurance payments daily to establish accurate AR.
Monitoring Claims and Remittances
- Check daily claims batches for receipt confirmation from both the Clearing House and the payers.
- Address and correct rejections immediately upon identification.
- Monitor remittances regularly; aim to post these on the same day they are received.
Weekly and Monthly Reviews
- Review AR reports weekly to track pending claims and address issues or require patient information promptly.
- Run AR reports monthly or bi-monthly to monitor payer balances and ensure timely payments.
- Analyze AR columns (current, 30, 60, 90, 120 days) to identify trends and potential issues.
Claims Management Strategies
- Track specific payer claims for efficient resolution; consider processing claims in batches.
- Resolve timely filing issues to avoid claim denials and delays.
- Regularly inform staff about ongoing issues like data entry mistakes that may hinder clean claim submissions.
Best Practices for Low AR
- Constantly manage claims and monitor payments to maintain low AR levels.
- Small practices might expect lower AR, while larger clinics tend to have a higher AR due to the volume of services.
- Use accurate data entry to avoid rejections and enhance claim processing efficiency.
Revenue Cycle Management
- Low Accounts Receivable (AR) essential for revenue cycle efficiency.
- Generate insurance AR reports to establish analytical baselines.
- Identify problematic insurers and low-payers; verify the accuracy of posted payments.
Claim Filing Processes
- Electronic claims preferred by insurers; many only accept electronic submissions.
- Partner with Clearing Houses like Gateway evi for streamlined claims processing.
- Utilize electronic remittances (ERAs) for centralized receipt of remittance advices.
Secondary Claims Submission
- Use Clearing Houses with online secondary submission features to enhance efficiency.
- Employ EDI services with alternative Clearing Houses like Availity or Identity for backup manual submissions.
Daily Management Tasks
- Submit claims daily to avoid backlog and maintain workflow.
- Track claim rejections closely and resubmit corrections quickly to sustain cash flow.
- Daily retrieval and application of insurance payments crucial for accurate AR monitoring.
Monitoring Claims and Remittances
- Confirm daily claims batches are received by both the Clearing House and payers.
- Address and rectify claim rejections immediately to prevent further issues.
- Regularly monitor remittances, aiming to post them the same day they arrive.
Weekly and Monthly Reviews
- Weekly AR report reviews help track pending claims and facilitate timely resolution.
- Monthly or bi-monthly AR reports necessary for payer balance oversight and timely payments.
- Analyze AR aging (current, 30, 60, 90, 120 days) to identify patterns and issues.
Claims Management Strategies
- Track claims by specific payers for efficient resolutions; consider batch processing.
- Timely filing issues need resolution to avoid insurance claim denials and delays.
- Ongoing communication with staff about data entry errors to promote clean submissions.
Best Practices for Low AR
- Continuous claims management and payment monitoring essential for maintaining low AR.
- Smaller practices naturally have lower AR, whereas larger clinics experience higher AR due to service volume.
- Accurate data entry is crucial to minimize rejections and optimize claim processing efficiency.
Revenue Cycle Management
- Maintaining low Accounts Receivable (AR) is crucial for enhancing revenue cycle efficiency.
- Begin with an insurance AR report to create a baseline for performance analysis.
- Identify problematic insurance providers and low-paying entities; ensure accuracy in posted payments.
Claim Filing Processes
- Electronic claims are favored over paper claims; many insurers exclusively accept electronic submissions.
- Utilize an experienced Clearing House, such as Gateway evi, for streamlined claims processing.
- Embrace electronic remittances (ERAs) to consolidate remittance advices in one location.
Secondary Claims Submission
- Utilize Clearing Houses with online secondary submission options to streamline operations and reduce costs.
- Consider EDI services through alternative Clearing Houses like Availity or Identity for electronic manual claim submissions as a backup option.
Daily Management Tasks
- Submit claims daily to avoid backlogs and maintain workflow.
- Monitor claim rejections closely and resubmit corrected claims quickly to ensure cash flow continuity.
- Retrieve and apply insurance payments daily for accurate AR management.
Monitoring Claims and Remittances
- Verify daily claims batches for receipt confirmation from both the Clearing House and payers.
- Address claim rejections immediately for prompt correction and resubmission.
- Regularly monitor remittances, aiming to post them on the day of receipt to maintain current records.
Weekly and Monthly Reviews
- Review AR reports weekly to identify pending claims and address issues requiring immediate patient information.
- Conduct monthly or bi-monthly AR reports to monitor payer balances, ensuring timely payment collection.
- Analyze AR columns for different aging categories (current, 30, 60, 90, 120 days) to spot trends and potential concerns.
Claims Management Strategies
- Track specific payer claims to facilitate efficient resolution; consider batch processing of claims for effectiveness.
- Proactively address timely filing issues to prevent claims from being denied or delayed.
- Regularly inform staff about persistent issues, such as data entry errors, that could adversely affect clean claim submissions.
Best Practices for Low AR
- Continuously manage claims and monitor payments to maintain a low AR level.
- Smaller practices typically have lower AR expectations, whereas larger clinics may have higher AR due to the volume of services they provide.
- Ensure accurate data entry to minimize rejections and improve overall claim processing efficiency.
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Description
This quiz covers essential aspects of Revenue Cycle Management, focusing on the significance of maintaining low Accounts Receivable and efficient claim filing processes. Participants will explore the importance of electronic claims submissions and the role of Clearing Houses in optimizing revenue cycles. Enhance your understanding of secondary claims submission and daily management tasks for improved financial performance.
