How to Boost Level 4 Payments in Medical Accounts Receivable

Healthcare providers ensure the swift recovery of patients, so they can return to their natural lifestyle. Physicians have all the expertise to ensure effective healthcare. However, billing complications make their job notably tough. On top of that, piled-up accounts receivable (AR) seems like the worst nightmare for them. Increased outstanding not only affect the clinic’s financial health but also hamper patient care at the same time. Eventually, smaller practices are facing closure due to weakened financial health and practice reputation.

Here, the efficiency of professional medical accounts receivable services comes with a welcome solution. They have the focused knowledge and experience to collect pending accounts before they become bad debts. Internal teams of healthcare accounts receivable experts can manage the collection. However, they are pretty expensive, especially for small-scale practices.

Among all claims, level 4 visits, billed under CPT code 99214, present significant billing complexity. Here, healthcare staff must ensure optimum precision in coding and documentation. On the one hand, procedure code 99214 represents complex, high-value care. On the other hand, if handled incorrectly, they are a major source of denied claims, lost revenue, and AR headaches.

Industry stats show that many of the denials were for 99214 visits. The providers had spent 35–40 minutes with patients and documented everything they could think of. Yet insurance companies were denying or down-coding these claims.

Here, the problem lay in the subtle gaps, such as:

• Documentation that didn’t quite match payer expectations
• Claims submitted without proper pre-checks
• Moreover, the internal AR processes failed to catch denials early enough

What Makes a Level 4 Visit So Tricky?

Application of CPT code 99214 requires careful observation and attention to details. This code is applicable to the following scenarios:

• An established patient’s office or outpatient visit
• Require a detailed medical history and/or examination reports
• A moderate level of medical decision-making, or
• A total encounter time between 30 and 39 minutes

Hence, 99214 apply when the particular patient has multiple health conditions. Here, in-detailed descriptions of diseases, test reports, and treatment plans are the optimum requirements. Unlike a simple 99213 visit, these encounters are inherently more complicated.

Insurance companies scrutinize claims with CPT code 99214 more closely. Medicare, in particular, flags 99214 for potential improper payments. It is because providers are right on the edge between moderate and high complexity. Here, payers can report improper documentation if they fail to find even a tiny detail.

How Level 4 Visits Affect Healthcare AR

Now, as we know, accounts receivable in healthcare significantly increase when the payer denies claims or underpays the requested amount. To retrieve the pending accounts, internal staff spend most of their working hours. They contact payers on any means available. They call them, or send mail to follow up with them and discuss the denial reasons for a clear overall picture. And while they’re doing that, new claims pile up. It’s a cycle that can spiral out of control.

In addition to that, if providers let the pending accounts linger for months; gradually they fall off their radar. With time, the ages of AR increase, and finally, they become uncollectible. Claims that age past 90 days, recovery becomes much harder. In the US healthcare industry, the age-old claims are referred to as bad debts.

Level 4 denials aren’t just about lost revenue. Rather, they affect the morale of internal staff. While dealing with appeals and resubmissions, staff get frustrated. Furthermore, providers feel their time isn’t being valued. As a result, the practice’s cash flow suffers. AR experts step in here with a different approach. They have dedicated staff that monitor claims daily, chase denials promptly, and understand payer-specific rules.

Common Pitfalls in 99214 Billing

In the healthcare industry, it is no surprise that small errors lead to large losses. It can affect the practice’s reputation and finances at the same time. The common 22914 coding mistakes are:

In our observation, many providers often under-code out of caution. In many cases, they wrongly choose 99213 when the complexity supports 99214. While this may reduce audit risk, it also reduces reimbursement.

On the other hand, over-coding leads to even more reimbursement problems. If providers submit claims with 99214 without supporting documentation, insurers will either deny or down-code them.

Another common reason for payer denials is subject to documentation gaps. Even when a provider performs the right work, if the note doesn’t reflect it clearly, payers will surely reject the claim. Documentation errors are usually triggered by the following:

• Missing a review of systems
• Unclear decision-making notes
• Time not recorded accurately

Then there’s the timing issue that is referred to as the appeal timely filing limit (ATFL). If denials aren’t appealed promptly, the chance of recovery diminishes. In our experience, most healthcare practices lose revenue not because claims are coded wrong. Rather, it is because they aren’t followed up on in time.

Finally, smaller medical practices often lack proper, qualified resources due to a limited budget. Maintaining a full internal team for healthcare accounts receivable management capable of handling high-volume 99214 claims is expensive and challenging. That’s why outsourcing medical accounts receivable services can make a huge difference.

How AR Experts Can Transform Your 99214 Reimbursement

AR specialists do more than process claims. They act as an extension of your billing and clinical teams. These dedicated specialists conduct a comprehensive audit of past claims. It enables them to recognize the following:

• Where revenue was lost
• What denials occurred
• Where documentation gaps exist

After recognizing the denial reasons, the third-party accounts receivable experts work with providers to strengthen notes. Here, they ensure that every 99214 visit clearly supports the medical decision-making, i.e., of moderate complexity. Also, they need to check whether the time spent with patients is documented properly.

Pre-submission checks are another critical step. AR experts verify proper diagnosis-to-procedure alignment, required modifiers, and payer-specific requirements. It’s amazing how many claims fail for something as simple as a missing modifier. By catching these issues before submission, they reduce the risk of denials significantly.

When denials do occur, AR teams handle appeals efficiently at the quickest. They gather supporting documentation (Sometimes request addenda from providers) and submit appeals within the deadlines. Because they deal with multiple payers every day, they know what each insurer needs to overturn a denial.

Beyond Reimbursement: Other Benefits of AR Management

Outsourcing to medical accounts receivable services is about more than just money. It improves efficiency and frees up internal staff, as well as reduces burnout. With their assistance, internal staff no longer need to spend hours chasing unpaid claims. Hence, when they have ample time, providers can focus on patients rather than paperwork.

This way, practices gain visibility into the common trends. They can sincerely evaluate denial patterns, payer behavior, and provider-specific issues. On top of that, third-party AR experts also foster continuous improvement. It enables the practice to build a culture of accuracy and efficiency. Moreover, outsourcing makes denials less likely and reimbursement more predictable.

Essential Lessons for Seamless Healthcare Accounts Receivable Management

First, seamless and continuous communication is key. Healthcare practices should treat AR specialists as part of the core team. Moreover, billing staff must understand the importance of accurate and comprehensive documentation. The outsourced AR experts must also seamlessly integrate with clinical workflows. It will keep everyone engaged in this process thoroughly informed.

Second, providers should have realistic expectations regarding their tentative collections. They must understand that every outstanding account cannot be recovered. Here, they must target the accounts which have the promise of collection.

Finally, practices must adopt small interventions that often make a huge difference. They must thoroughly conduct the following to collect pending revenue without a massive investment.

• Pre-submission checks
• Targeted provider training
• Prompt appeal follow-ups

By adopting these three features, practices can streamline their AR. However, it will require significant expertise. Now, AR experts are not easily available and are pretty expensive. Here, third-party AR specialists like SunKnowledge Inc. ensure maximum collection at a significantly affordable rate.

Connect with SunKnowledge to Outsource Medical Accounts Receivable

SunKnowledge has a team of experts who have an in-depth understanding of medical codes. Hence, with our assistance, practices can maximize 99214 reimbursements and eradicate denials. To streamline collection, we thoroughly implement pre-submission checks. That makes our first-pass acceptance rate almost 97%. In addition to that, we manage appeals flawlessly and provide analytics that inform workflow improvements.

Hence, with our right support, level 4 visits become a reliable source of revenue instead of a constant source of stress. So, if you think that your clinical effort deserves to be reflected in fair reimbursement, contact us to make that possible. Our top-notch medical accounts receivable services will not only uplift your financial strength but also enable you to improve your patient care ability.