1. Claim Submission Review ✔ Verify claims are submitted within 24-48 hours of service✔ Confirm electronic submission rate >95%✔ Check for missing/invalid codes (CPT®, ICD-10, modifiers) 2. Payment Posting Accuracy ✔

1. Identify Root Causes ✔ Run a denial trend report – Categorize by: 2. Top Denial Types & Quick Fixes Denial Reason Immediate Action Long-Term Fix Eligibility

1. Front-End Optimization ✔ Real-Time Eligibility Checks – Verify coverage before visits✔ Pre-Authorization – Secure approvals for high-cost services✔ Point-of-Service Collections – Collect copays/deductibles upfront 2. Claim Submission Best Practices ✔ Electronic

1. Setting Up Payment Plans ✔ Assess Financial Need: Offer tiered options (e.g., 3/6/12 months)✔ Clear Terms: Put agreements in writing (amount, frequency, late fees)✔ Automate Payments: Use

1. Key Metrics to Analyze ✔ Aging Buckets – Focus on 60+ day claims first✔ Payer Trends – Identify slow processors (e.g., Medicaid vs. commercial)✔ Denial Reasons – Target high-frequency issues

1. Eligibility & Registration Errors Code Reason Solution CO-16 Claim lacks info Resubmit with complete patient/insurance details CO-18 Duplicate claim Verify if original claim was

A strong appeal letter can recover 30-50% of denied claims. Follow this proven structure: 1. Header Essentials ✔ Patient name, DOB, ID #✔ Claim #, Date

1. Tiered Follow-Up System Days Outstanding Action 0-30 days Monitor via payer portals 31-45 days First follow-up (phone/email) 46-60 days Escalate to payer rep 60+

An Accounts Receivable (A/R) Aging Report categorizes unpaid claims by how long they’ve been outstanding. It helps identify billing bottlenecks and prioritize collections. 🔹 Key Columns to

The AR cycle represents the financial workflow of converting medical services into payments. Optimizing it ensures steady cash flow and reduces revenue leakage. 🔹 6 Key Stages