Working Aged Receivables

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A great way to make real progress is to determine and outline a segmentation strategy that codifies the accounts for action by payment disposition and/or follow-up status or activity code.  Initially, determine if the account has been billed as accounts can slip through the cracks. Should it be re-billed? Is there an active root-cause remark (CARC/RARC and other remark codes) readily available? Segment accounts for follow-up efficiency. For example, if accounts are awaiting payment due to missing or incomplete information which can be gathered quickly, then separate those accounts from claims that require deeper research or intervention such as coordination with HIM or Case Management.

The following are some examples of key Claim Follow-Up Segments which can help with organizing a Follow-Up Segmentation Strategy:

• Promise to Pay Date - Payer 
• Promise to Pay Date - Patient / Guarantor
• Missing Information - Claim Incomplete
• Missing Information - Clinical / Medical Necessity Requirements
• Missing Information - Attachments Required
• Denial Root Cause:  Administrative (Claim & Billing based Denials)
• Denial Root Cause:  Clinical / Medical Necessity
• Underpayment - Payer
• Underpayment - Patient/Guarantor
• Overpayment - Payer
• Overpayment - Patient/Guarantor
• Adjustment Processing - Administrative
• Adjustment Processing - Bad Debt / Write-Offs
• Account Transfer to Agency - Collection Agency
• Account Transfer to Agency - Specialty A/R (TPL / Liens / Complex Denials)
• Small Balance Write-Off
• Credit Balance Processing - Adjustment Reconciliation
• Credit Balance Processing - Refund Patient / Guarantor
• Credit Balance Processing - Refund Payer

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