In Part I of this blog series, we started talking about some important reports to run to monitor your AR and achieve Gold Standard Billing. We continue that discussion with the second half of critical revenue cycle management reports:

Forwarded Status {Weekly}:
Make sure to run a report to check claims that are in a forwarded status as they’re often easy to forget about. Ideally claims should not be in forwarded status for more than 7-10 days. After this allotted time, open a case with your billing processor to investigate the claim(s). If the claim has not been processed 10 days after filing an investigation, re-file the claim.

Pending Claim Status {Weekly}:
Any claims that are pending should be resolved within 48 hours. Pending claims should also be pulled and processed with the practice and the batch balanced within five working days. Any pending claims that can’t be resolved should be escalated to senior billing staff for review and resolution.

Payment Receipt & Posting {Bi-weekly}:
All payments should be deposited and posted as revenue in your EMR/PM system within 48 hours of receipt. All payments should be balanced by the end of the work shift. Any discrepancies should be escalated to a supervisor.

Claim Denials {Bi-weekly}:
Any claims that are denied should be resolved within three working days of receipt.

Reconcile Appointments to Charges {Daily, Bi-weekly}:
It’s important to cross reference kept patient appointments with corresponding claims to ensure all patient visits have been billed. Ideally this report is ran daily as well as in conjunction with billing meetings.

Claim File Reconciliation {Daily}:
Once a claim has been submitted to your clearinghouse, check the status of the file delivery and the status of all the claims in the file. This makes sure all claims were sent to the payer. Any claims that are not acknowledged by the payer within 10 days should be investigated with your clearinghouse.

Reconcile Batches {Daily}:
Process and balance all of your claims batches within two working days of creation.

It takes a lot of hard work and dedication to achieve Gold Standard Billing however the efficient workflow and revenue cycle are definitely worth it. Take a moment to compare the reports you’re already running with the ones we mentioned.