Medforce Blog

What an AR Manager Needs

August 17, 2017

Category: General

Your AR team is responsible for making sure you receive as much of the revenue you’ve earned as possible. And as we noted before, they should be a profit center while doing this work

AR departments in healthcare companies can vary widely in size.  They can be one person or many. But regardless of size, what an AR manager needs to be effective remains the same:
visibility and control.

This breaks down into two broad buckets: the daily work and the strategic work.

Daily Work

On a day-to-day basis, you need to know what is happening in your department so you can step in when needed and also anticipate problems before they arise. Real-time reporting is crucial.

  • See what’s coming in. On a day to day basis, the manager needs to have a full picture of what’s coming in, who it’s assigned to, and to easily ensure it’s being worked appropriately. This includes new claims going out (which may hit your AR department in 30 days) and new denials or partial payments, daily.
  • Assign the work appropriately. Assigning by payer and alphabet is not a good division of labor. You need to know the strengths of your team and make sure that work is assigned based on those strengths.
  • See what is being done. You need to see what is in motion, real-time. You need to know what your team is actively engaged in at that exact moment.
  • See what is not being done. Equally important to knowing what is happening is knowing which items are currently in a hold mode, waiting for a response. You need to make sure nothing slips through the cracks or is getting too close to a deadline.
  • How quickly the work is being done. This is not just about productivity but also about identifying when an employee is struggling. If you expect an invoice to be worked in a certain amount of time and it has gone beyond that, a red flag should be thrown and you should investigate further. If a person is working Aetna how many claims should they be able to work as opposed to Medicare or Medicaid. Not all claims and not all denials are created equal, and you should have an understanding of what benchmarks should be so you can assess challenges.

Strategic Work

On a higher level, you need to be ensuring performance and productivity. You need to intimately understand your AR pipeline to get ahead of issues, anticipate cash flow appropriately, and step in when needed.

  • Identify bottlenecks. Where in your process are invoices getting hung up? Is it a process issue? A staffing issue? Being able to see everything will show you where your bottlenecks are. For example, do you have a documentation person that reviews medical docs before they are used to appeal a claim? Is that falling behind? Could simpler paperwork be reviewed by the AR team so they don’t need to wait on the documentation process? Do you have an Auth specialist? Is that backing up AR work?
  • Identify trends. Gut feel isn’t always accurate and sometimes doesn’t lead you to the highest strategic priority. The squeakiest wheel might get the oil, versus the one that will return the biggest impact to your bottom line. Data can help you truly know what will have the biggest impact and can also sometimes surface unexpected areas of opportunity. Putting it all of the data into one spot where you can cut it in a variety of ways will give you new insight.
  • Understand success factors. What is working and what is failing? And what are the root causes?  If appeals are all failing – why? If some are failing compare them to the successful ones – are they being submitted differently? What can you learn from your successes to minimize failures in the future?
  • Establish and enforce best practices. Once you have insight into your AR pipeline, what works, what leads to success, when to call, when to get more documentation before you appeal – you take the guesswork out of success.

One of the biggest challenges for AR Managers is that a lot of these needs are not adequately addressed in your billing software. There isn’t enough detail or data to optimize your AR processes. Taking your AR out of your billing system, moving your reporting to real-time instead of static spreadsheets, and improving your ability to learn and refine over time will help you bring your AR team to the next level.

Learn more about the Medforce Accounts Receivable Management App or read our recent case study: Boosting Productivity in Accounts Receivable.

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