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Accounts receivable (A/R) is all of the claims you’ve sent and not yet paid. There are two types of strategies. Active A/R follow-up moves ongoing claims while they are still young, before their time passes for filing the claim. Past due A/R is a once-in-a-lifetime project that addresses a backlog from the previous biller or new billing system. They both use your aging report, sorted into batches by payer and underlying problem.
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Medicare timely filing from the date of service, the outside recovery period
Days allowed in many commercial and Medicaid MCO contracts, much shorter
MGMA-referenced goal for AR after 90 days for excellent practices
Our first status check after we send a claim, before it gets stuck
AR follow-up is the monitoring and resolution of unpaid insurance claims. This process involves status inquiries for EDI 276 and 277 in behavioral health. AR follows the process from root cause analysis through resubmission, escalation, and closure. This is aimed at ensuring claims are resolved before the timely filing period ends. AR healthcare AR recovery services transform an aged claims report into resolved claims.
This process is clearly separated based on the current claim status. Status inquiry and chase is needed for a no response claim. Comparison against contracted rate and recovery is needed for an underpayment claim. Call to the provider’s line on the payer is required for a stalled claim. AR medical billing recovery services resolve each one of these to posting or adjustment. No claims sit around as their filing periods expire.
Fresh claims. Claims at this level must be the majority of the aged claims portfolio
Aging claims but still workable. The failure to have a status inquiry here leads to a claim aging.
The danger zone. Filing periods begin expiring for commercial insurance plans here.
High risk. These are the parameters the MGMA benchmark uses against total AR.
Triage first. Every claim is evaluated for its potential to be filed before doing any work.
Behavioral health AR does not work like medical AR in the same way. Claims are small and there are many. The insurance may be at another company that does not show on the card. Secondary balances have trouble in coordination of benefits. Each one of these patterns causes the build-up of outstanding AR in the behavioral health clinic.
A behavioral health claim is a low-dollar claim compared to a surgical claim. An older backlog in behavioral health consists of many small claims, not a few large claims. The team responsible for AR works based on prioritizing claims by their size. The small balance requires more sophisticated batching strategies rather than working with each claim separately.Fresh claims. Claims at this level must be the majority of the aged claims portfolio
Many commercial plans separate behavioral health from the rest and outsource the benefit management. So the insurance may be under Cigna or Anthem, but the benefit is actually managed by Evernorth or Carelon. Sending a claim to the medical plan leads to no responses forever. We check the correct payer and resubmit the claim to Optum, Magellan or Lucet depending on the plan.
Medicare + Medigap combo divides a single benefit into two payers. Commercial and Medicaid combinations do the same. Both types of claims get stuck under COB processing and post a CARC 22. Behavioral health makes up a large number of such secondary offsets. Primary remittance is included and secondary claim is resubmitted separately within its own deadline.
Inpatient and partial hospitalization program days are left unpaid because the concurrent review was missed or authorization was inadequate. Such an offset is a failure upstream, not a follow-up one. Problem area and solution are identified in the prior authorization section. The facility portion of this task can be found on our facility billing page.The key point to remember: when it comes to behavioral health, old AR is not a handful of major claims. It has hundreds of minor claims. The processes that allow the recovery of those claims work in bulk.
This workflow involves five phases. Aging reports get segregated into batches. Status is swept through EDI and via phone calls. The root cause gets identified. The correct action gets sent out. The outcome gets posted and recorded. Each of the above phases has a deadline attached to it.
The aging reports are segregated into batches based on payer and root cause in order of filing urgency.
Claim statuses are reviewed using EDI 276/277, payer portals, and provider phone lines.
No response, denial, and underpayment are all different scenarios and require different actions to be taken.
The claim gets resubmitted to the correct organization or correct claim is submitted. COB issues are handled and escalated.
The payment is posted, the result is documented, and a reason code is entered in case of write-off.
A claim that has a denial moves to denial management for appeal processing and resubmission. A claim with no answer, underpayment, or slow-moving status remains in AR follow-up. Overdue denials outside of the appeal period move back into our process as write-offs. We maintain control over the aging process through our rhythm. Status checks for each claim occur within 7 to 14 days from the date of submission. There is no claim over 30 days without documentation.
Every Month Of Delay Converts Recoverable AR Into Write-offs
The filing deadline does not stop. Submit your aging report to us. We will help you determine which claims are actionable, underpaid, and in need of an adjustment.
Legacy AR recovery is a one-off project with regard to an old backlog. It arises where a previous biller had abandoned certain claims. It happens where staff turnover means that the aging report was allowed to languish. It happens where a new practice manager comes in and is confronted with a very heavy 120+ bucket. Each claim is a legacy issue handled separately from other current claims.
A changeover in billing software or electronic health records will leave behind some unworked claims from the old system. Staff turnover means that the aging report has been put on ice for several months. The incoming practice manager opens the books and confronts a very heavy 120+ bucket.
We check each legacy claim against the timely filing period available through the payer before proceeding to work it. Medicare requires a 12-month period from the date of service. Many commercial or Medicaid managed care contracts allow for 90 to 180 days. If a claim has passed that deadline, it cannot be collected and should not even be worked on.
The reporting distinguishes between three categories. The recovered claims indicate the money which came back to the practice. The adjusted claims show the money which was written off along with the reason for that action. And finally, the in-process claims reflect the activity which is still being done.
Some old AR is already dead. A claim that comes after the timely filing date or is associated with terminated coverage will not be paid, and anything else cannot change that situation. We move the recoverable claims to payment. We write-off the dead claims along with a reason code for record-keeping. False hope with a dead claim just results in delayed adjustment which has to be done anyway.
Unpaid does not imply wrong pay. The claim may still be closed although it was billed below the contracted rate. AR efforts will also generate overpayments that have their own requirements. They are done in the follow up. An overpayment is collected while an underpayment is refunded.
The payer may pay using a lower rate than what was contracted. The fact that the payment is made means that the variance can easily be determined. Payments are matched with the fee schedule to determine the variance. In case the payment was underpayment, the claim will still be recovered and not closed.
Overpayments and credit balances are some of the results of our AR efforts. In case the payer is Medicare, we must report the overpayment. This is because of the Affordable Care Act 6402.
The follow-up process for AR has to be constant and non-stop. Your front desk people are always monitoring the statuses of patients in between calls, on hold with payers, entering and exiting portals. The flow breaks, and your old report turns into wallpaper. The dedicated team prepares the report as a core task, not an additional one.
Your front-desk team is answering phones, scheduling appointments, verifying benefits throughout the day. AR calls do not win every single time against a patient call. Your hold times and portal activities of payers ruin your chances of having any flow. Your aged BH claims grow older in silence while urgent calls from your front office win the race.
We process aged behavioral health claims as a whole workflow split by payers and root causes. We are a US-based team operating under your current structure. Your aged report will be processed according to a certain schedule, not when somebody spots an opportunity.
It will be up to you to decide what all will be written off and adjusted prior to posting. It will be your decision as to what we will do regarding patient balances. It will be based on your decision that we will perform our insurance-AR cycle.
Some numbers will tell you that AR is in good condition. Days in AR represents the number of days that claims take to move through AR before payments are made. Percent of AR over 90 days measures the proportion of your AR that turns out to be old enough for risk. Net collection rate tells you what part of the collectable amount is being collected. The three measurements are reported each month with respect to industry standards.
The number of days in AR is the average number of days between billing and payment. Industry benchmarks suggest that it should be less than 40 days, and the best result is under 30 days according to MGMA. The measurement is calculated by payers because only one payer can spoil all the average.
It is the percentage of accounts receivable older than 90 days. According to industry standards and MGMA, in general, the measurement should not exceed 15-20 percent. The best result is single digits. This measurement is growing as follow-ups get worse.
The fact is that we work with collecting insurance accounts receivable on behalf of the insurance company and not from your patients. We never make any collection phone calls to your patients. We do not have anyone reported to any credit agency. Our company does not work in FDCPA type of collections. Insurance AR is what we specialize in, and patient balance collection is conducted according to your requirements.
It is especially relevant for the behavioral health practice area. The therapeutic alliance cannot survive a collection phone call, and you are right doing everything possible to preserve it. Anyway, the place where you have collectable money is insurance AR. And patient balance collection remains soft in nature.
We work in behavioral health AR for practices across all 50 states. Timely-filing windows and prompt pay laws vary from state to state and affect the management of aged AR differently. The state’s prompt pay laws make the payer to take action on the clean claim that it is sitting on. Filing requirements for each state are listed below:
| State | AR Recovery Services |
|---|---|
|
California |
Filing guidelines vary with Medi-Cal county plans. The prompt-pay law in California applies pressure on payers to do something about clean claims. |
|
Texas |
The Texas prompt-pay statute has some teeth when it comes to late clean claims. STAR MCOs use their own timely filing windows. |
|
New York |
File deadlines vary with Medicaid managed care plans and HARP plans. Prompt pay laws support escalations on stalled claims. |
|
Florida |
MMA Medicaid plans each have filing windows. They operate in conjunction with a large Medicare Advantage population. |
|
Georgia |
Georgia Families CMOs each have filing requirements. The carve out determines the destination of the claim. |
|
Tennessee |
TennCare operates only through MCOs with varying timely filing windows. Each claim is filed through a managed care plan. |
|
Arizona |
AHCCCS utilizes behavioral health through RBHA plans. Regional plans each have a filing deadline. |
|
New Hampshire |
Medicaid managed care establishes requirements for filing. Prompt pay laws at state level encourage escalation of commercial claims not paid. |
|
Mississippi |
Each of the Medicaid coordinated care organizations sets a filing deadline. |
|
Washington |
The Apple Health managed care establishes Medicaid filing guidelines. The state-level prompt pay laws encourage escalation of commercial claims. |
|
New Jersey |
Each NJ FamilyCare MCO has a filing deadline. State prompt-pay law pressures payers on stalled clean claims. |
|
Illinois |
The HealthChoice Illinois MCOs have a filing period for each of them. Different carve-outs will depend on which plan is serving the member. |
|
Pennsylvania |
Regional HealthChoices Behavioral MCOs establish their own filing period. The carve-out area determines which plan will review. |
|
Massachusetts |
MassHealth plans establish a filing period, with strict parity enforcement on aged behavioral claims. |
|
Virginia |
The Cardinal Care MCOs each have an established filing period. The state prompt pay statute facilitates escalation for unpaid clean claims. |
|
Colorado |
Regional Accountable Entities determine the Medicaid filing requirements. The state prompt pay statute facilitates escalation for commercial claims. |
|
North Carolina |
NC Medicaid Tailored Plans establish behavioral filing periods. Aged claims go to the plan that serves the member. |
Practicing in a metro area and looking for services nearby? We manage AR for behavioral health practices in NYC, Los Angeles, Chicago, Houston, Dallas, Phoenix, Philadelphia, San Diego, Miami, Atlanta, Boston, Seattle, Denver, Washington DC, the Bay Area, Minneapolis, Charlotte, Nashville, Austin, Detroit, Tampa, and Columbus. With a nationwide footprint, no state ever constrains us.
AR Follow-up is the process of tracing and resolving unpaid insurance claims. This includes status checks via EDI 276/277, root cause analysis, re-submission, escalation, and resolution. The objective is to resolve each claim before its timely-filing period expires. In behavioral health, AR Follow-Up happens in batches according to payer and root cause.
This is relative to the timely-filing period defined by the payer. Medicare allows one year from date of service. Most commercial and Medicaid MCO contracts operate at 90 -180 days. Once that timely filing period has elapsed, the claim is normally considered uncollectable no matter how accurate. We evaluate every aged claim against its timely filing period.
Absolutely. Transition Runoff is a common old AR project. We receive your prior systems' aged claims and validate whether each is within its filing and appeal period before attempting collection. Valid claims are collected. Unsuccessful claims receive a write off with reason code instead of indefinite aging.
Not at all. Mental Health Billing Services is a billing firm, not a collection agency. We handle insurance companies' payment claims and not your clients' funds. No collections will be conducted by us – we neither call clients for payments nor submit any of them to credit bureaus. The aging of balances is according to your practice's policy.
Generally, AR over 90 days should amount to no more than 15-20 percent of the total accounts receivable. Best performers quoted by MGMA have only single-digit ratios, about 5-8 percent. This rate is dependent on the payer mix and specialty of your practice. Our reports will provide you with information on the performance in comparison with the benchmark each month.
The decision is made according to the following rules. In case there is a denial in our records, the claim goes to the denial management department for further appeal/claim resubmission. When there is either no response, underpayment or a slow-moving claim, it should be sent to the AR follow-up department.
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