7-2 Milestone Three

1 7-2: Milestone Three HIM-660 Dr. Givens
2 Introduction Having strong billing department is essential to any facility. Having a team to submit clean scrubbed bills in a timely manner and staff to follow-up on unpaid claims will keep the revenue flowing in and not losing money on claims not yet submitted, corrected or follow-up on. Faster revenue for your practice - as the insurance claims are processed on time and accurately, the service ensures you rapid cash flow (Clements,2023). Current issues being faced Communtity health has $525,869 payments outstanding from services rendered and this figure is only taken into consideration claims from Insurace carriers, this figure doesn't even include self- pay outstanding claims. This is a high number and the facility is losing money. These outstanding figures may be from claims on hold that have not yet gone out but also those that have not gone out and have outstanding balances not yet paid. This is detrimental to a facility and the billing department would need to employ team members to work the late A/R claims to determine why these are still outstanding. The hospital uses resources and are not being reimbursed for the time, services and equipment used, the hospital is basically doing services for free in that instance and that can cause the hospital to lose too much money and get into real trouble. Recommendations to improve timely billing and why it is important The recommendation would be to implement a strong EHR system which can formulate aging reports that can specify outstanding claims and can be printed and worked monthly. For the time being with will employ staff for a special project to work the oldest aging reports and claiming
3 payments for those still eligible. Unfortunately once a claim goes out of timely filing for follow- up and payment it will need to be written off as a loss. Once that special project is completed we will form an A/R only billing team which will break up to form smaller teams to work on different insurances and self pay patients. The benefits of timly and accurate billing is huge. By submitting a clean scrubbed accurate claim on time, it will bring in revenue much quicker into the facility, Settlements with the insurance can happen much quicker and have higher profit, a correct claim that is filed on time will have less denials which now will take time to submit appeals and corrections. All processes of claim management is important but our aging reports has many outstanding balances and attention needs to be focused there to bring in revenue owed to the facility. Important resources A strong EHR system with the capabilities to print detailed and specific A/R reports is essential. This will make viewing and collecting the payments easier. A good clearinghouse is also important for scrubbing the claim and ensuring it is clean for submission to carriers. A strong billing and coding team, one with a strong follow-up team to ensure bills are being paid and collected. The billing team will need to set a weekly billing submission and keep track of any claims on hold or that bounce back due to issues. Submitting a claim past an insurance's timely filing limit will come back to you as Claim Adjustment Reason Code (CARC) 29 and state, "The time limit for filing has expired." CARC 29 has a high chance of prevention but a low overturn rate. Simply put, it has a low chance of appeal after you've received the denial , thus you lose money ( moneypenny,2019). We also make sure billers know the guidelines for timely filing which is:
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