Setting The Benchmark in AR Follow up/Denial Management in Medical Billing

Dual exposure and a unique edge in making our clients more successful in their business in a much shorter timeframe, that’s Sunknowledge for you! We are in fact the only practice management/ medical billing Company , working with both payers and providers including major success in Hospitals, Orthotics and prosthetics, DME, Nursing homes, urgent care centers , specialty pharmacy , genomics labs and many more. We have our own proprietary platform in telemedicine elevating and easing care management priorities.

A 360 degree Revenue Cycle Management approach

Our complete action plan defines your medical billing with improved financial performance. We believe in seamless integration between your front and back offices yielding greater efficiency. We cater:

♦ Eligibility verification
♦ Patient demographics and information entry
♦ Medical Coding
♦ Charge Entry
♦ Claim Submission
♦ Payment Posting
♦ Accounts receivable
♦ Denial management
♦ Customized reporting

Accounts Receivable Management: Process Overview

The process begins after the Provider creates and sends Health Insurance Claims (Electronic/Paper claims or Manual HCFA forms) to various Insurance Companies. Depending on the transmission type and length of time since submission, we begin our follow-ups. Our A/R follow up service is designed specifically to increase revenue collection.

There are two types of claims follow ups:

1. No Remark Claims: Any claim in which absolutely no status is known for the claim.
2. Last Remark Claims: Claims which remain unpaid for various reasons. These claims are routinely followed up on a monthly basis.

Key components of accounts receivable: 14% of all claims submitted to the payers are denied and have to be resubmitted, appealed or written off by providers.50% of denied claims are never re-filed.50-70% of denied claims have higher chance of being recovered.

Follow-up with Payer

Aggressive follow up with the insurance company’s on all accounts at any stage of the aging bucket plays an important part in A/R follow up activities.

Closure of claim

Our AR team responsibility will be in reducing days in A/R, claims submission and improving collection ratio. An increase in profitability of the payment through a process of timely follow up will be our core objective!

The Sunknowledge approach in Accounts Receivable follow up

1. Online Claims Follow-Up

Using various insurance company websites and Internet payer portals, we check on the status of outstanding claims.

2. Automated Claims Follow-Up (IVR)

By calling insurance companies directly, an Interactive Voice Response (IVR) system will provide the status of unpaid claims.

3. Insurance Company Representative

If necessary, calling a ‘live’ insurance company representative will give us a more detailed reason for claim denials when such information is not available by the first 2 methods.

The highlight of our benefits

The reason we are your preferred partner, we just go ahead in providing you a complete solution in your medical billing efforts. We guarantee:

• Reduction in accounts receivable by 30% within 1 month
• Accounts Receivable recovery cost starts from 2.5%
of collections
• Expert handling of accounts receivable by highly experienced staff
• Demonstrated expertise in working on difficult-to-recover aging A/R
• Same attention to every cash amount regardless of its size or source
• No write offs or adjustments without client consent
• Helping major insurance companies in their credentialing and claims adjudication mandates

Let us demonstrate our value proposition, share references across leading industry participants, and illustrate our functional best practices. We guarantee you of improved collections, dedicated account management support and seamless communication standards.



Leave a Reply