Take Control of Your Medicare A/R
By Linda Payne, President, Reimbursement Concepts, LLC
Situation: An acute home infusion company with a large regional presence requested assistance with their large (and growing) Medicare A/R. Their denial rate was exceptionally high and their over 120 day aging was large and growing.
Problem: They had used the same Medicare payer set up for their payment as well as for their Medicare for technical denial invoices. There was no way to see which invoices they truly expected payment from Medicare on when calculating DSO and when doing cash forecasting.
Cause: They did not have a Medicare for denial payer set up separate from Medicare for payment as payers within their reimbursement system in order to be able to run separate agings.
Impact: Skewed cash forecasting reports, denial rate looked highs, and cash as a percentage of booked revenue did not make sense. The team was spending unproductive time trying to identify by handwriting which patients were for payment off of a printed aging report.
Solution: Create a special payer for Medicare for denial so that separate Aged Trial Balances can be run and it is easy to run reports based on expected denial vs expected payment!
Prevention: When setting up a new or “tweaking” an existing system, take time to think about what you really want to be able to trend and validate in your reporting. Taking the time to get a group together to discuss what time of information is important to your company eliminates a lot of the manual calculations and work arounds that most people get caught up in.