Account Receivable, Insurance Follow up Services

Account Receivable, Insurance follow up services

Global Edge Usa, account receivables follow up services focus on low value and low margin accounts that make it difficult for you to profitably recover your revenues. We work on improving your cash flow by reducing the number of days in AR by increasing the ratio of your collections and profitability. An effective account receivables management allows our customers to improve their revenue which has great bearing on efficient operations and can impact business scalability significantly.
Global Edge Usa Accounts Receivable Services guarantees quicker payments, improved cash flow and allows your employees to concentrate on higher value added activities which also help in employee retention and motivation.

Our team of professionals receive extensive training and are well versed with billing terminology and revenue cycle. All our work is audited in house, ensuring compliance with accuracy and efficiency.

Global Edge Usa Insurance Follow up

Global Edge Usa follows a comprehensive insurance follow up process that’s provides, collectors with necessary automated tools, proper training and reporting to resolve old account receivable and generates revenue from unpaid or slow paying insurance accounts. By using an aged AR report, our trained professionals contact insurance companies directly in order to determine the status of the claims on the given outstanding claims. Global Edge Usa ensures maximization of collection and efficiency. We follow a pro-active approach keeping quality, accuracy and compliance in mind.

Some examples of servicing options include:
• Federal Insurance
• Commercial insurance Follow up
• Managed care
• Worker’s Compensation/MVA/PI

Federal Insurance
Our software and knowledge are always up to date as per Medicare guidelines. Global Edge follow up solution is focused on ensuring that insurance will always receive clean claims and to fulfill the same, maximum of the primary as well as secondary claims are being submitted electronically. We also ensure frequent use of the insurance websites for effective and timely follow up.

Commercial Insurance Follow up
We have an excellent record in handling commercial and managed care plans. To make our services more effective and faster we have enrolled our self with all big payers to use their online services for insurance verification, claims status and ERA. All major procedures are filed with authorization on behalf of the provider as per their contracts. We have thorough experience in all PPO plans like BCBS, Aetna, Humana, Cigna, Great West, AARP, GHI, United Health Care, United medical resources (UMR), First health, Mega Health, Magna Care, Secure Horizon, PacifiCare, Mutual of Omaha, Inter Plan Health and many more.

Managed Care
Managed care plans tend to delay payments, as they require a lot of documentation, authorization requests and Out Of Network (OON) processing. Our teams are highly experienced in handling issues for timely processing of claims. We also provide credentialing facilities to providers so they can get rid of ONN processing’s and gain good reimbursements.

Worker’s Compensation /Motor Vehicle Accounts/Personal Injury
This is the area where are expertise comes in, Global Edge Usa has extensive experience on WC, We have highly trained professionals who know how to get paid for these claims. We handle many big accounts which only deal with WC, personal injury and Motor Vehicle accounts, we send documentations, file liens, call attorneys and judges; send non-appearance letters, offer negotiations and settlements. For Personal Injury Accounts we perform call layers, send statements to attorneys and we do out of court settlements and continue until it’s resolved.

Our Account Receivable Service includes:

Aging Analysis – Analysis of a situation is always necessary to proceed in the right direction, and that’s exactly what we do. We run an aging summary report when we start working on a new account. At the end of the month, a new report is generated and is compared with the initial summary report to check on improvement and accordingly we work on the areas of concern.
Payer Follow up – Our team of professionals are experts in working upon federal and non-federal insurances (PPO, EPO, HMO, IPA, MVA, WC, PI, DME). Which includes Medicare, Medicaid, Tricare, BCBS, Aetna, Humana, Cigna, Great West, AARP, GHI, United Health Care, United medical resources (UMR), First health, Mega Health, Magna Care, Secure Horizon, PacifiCare, Mutual of Omaha, Inter Plan Health and many more.
Denial Trend management – We have a dedicated team which only works to define the denial trends associated with different insurance’s. This is done with the help of denial EOB’s and comments being entered in the system by the AR followers.
Reporting –A basic reporting structure has been defined into three steps –Daily reporting, weekly reporting and monthly reporting. Further this can be defined or modified as per the client’s requirement.

Software’s Expertise

Global Edge Usa has experienced and well trained specialists that are well versed with different billing software’s such as Medical Manager, e-clinical, Intergy, SurgiSource, Misys Tiger, Acer-Med, elligence, Medaxis, CPR plus, Parcs, Medisoft, MD Synergy, Advanced MD, Claim Manager, Alta Point, Manage MD, AdvantX, Nextzen, Office Ally, Kareo, CompuMed, Professional Studio, Sequel Med, Medrium, Practice Studio, Amazing Charts. We also provide a dedicated in-house training and development program that helps the staff inculcate a wider understanding of the entire process, which in turn will help them to adapt to any new software seamlessly and replicate the process.

Tools Used for AR follow up

Account Receivable Analyst uses the following tools, reports and documents to identify and investigate issues that are affecting cash flow and preventing timely and accurate reimbursement of claims by payers. One or more and sometimes all of the following tools, source documents and resources are required for a complete and effective AR follow up:
• Patient Account Ledger
• Explanation of benefits
• Regular mail or correspondences
• Account Receivable calling
• System reports like
1) Aged insurance/Aged AR Reports
2) Custom Reports
3) Financial Reports
4) Claim submission reports
5) Patient statement reports
6) User reports



ACCOUNT RECEIVABLE PROCESS

Step One – Report Execution
At the beginning of each month Account Receivable analyst runs an Aged insurance Report on the billing system using required parameters and identifies the claims that are unpaid or in appropriately paid. This report provides a list of outstanding claims pending against each insurance carrier.


Step Two – Identification of Account Receivables
From the above report, the account receivable analyst selects claims that remain unpaid beyond 30-45 days from the date of filing. The number of days depends on whether their claims were sent on paper (paper claims), or were transmitted electronically (electronic claims). Also, the number of days depends on the average turnaround time for the claims to get settled, i.e. from the date of filing of the claim to the date of receipt of payment for the claim.

Step Three – Identification of the problem –Review
Account Receivable analyst then reviews patient accounts ledgers pertaining to the unpaid claims to analyze why the claims are still outstanding. Analyst reviews patient ledger from the billing angle for possible violation of billing rule.

Step Four – Identification of the problem – Calling
If the claim has been prepared and submitted correctly as per insurance requirement, and usual turnaround time has been passed, call needs to be placed with respective insurance carriers to ascertain the status of outstanding claim.
Analyst or Account Receivable caller obtains the required information from the insurance company and documents the results of the call in the collection notes section of the patient account ledger. Based on the call notes, appropriate steps needs to be initiated to settle outstanding claims.

Step Five – Identification or execution of corrective action
Once issues or problems have been identified the Account Receivable analyst initiates action to resolve. Issues may be forwarded to one or more departments, or to the client, depending on the nature of the issue. Complete resolution of an issue may require inputs or action from more than one department.

Step Six –Identification of Un-collectible AR
Details of the outstanding claim balances that the Account receivable analyst considers uncollectible, and which may thus have to be written off, are forwarded to the client for decision-making. Details of outstanding claims, where collections efforts have failed due to non cooperation or lack of response from payers or liable parties, are also forwarded to the client.