Reducing AR Days from 68 to 35 for a Behavioral Health Provider with Proactive Follow-Ups
Service
AR Recovery & DenialsIndustry
Behavioral HealthLocations
1 siteProviders
8 therapistsTimeline
3–6 monthsRegion
USAbout This Project
A behavioral health practice employing 8 therapists providing psychiatric evaluations and medication management services had an AR balance exceeding $420,000, with 40% of its AR aging past 90 days. The average AR days were 68, and the small staff size could not manage follow-ups for unpaid bills. CureMed was retained to collect its AR and establish an efficient system for managing AR over the long term.
Challenges & Solutions
| Challenges | Solutions |
|---|---|
| Codes for behavioral health CPTs are time-dependent and demand accurate documentation since many claims were denied due to insufficient medical necessity justification. | Priority tiering system based on claims categorized according to their age, monetary amount, payer, and denial code, with high-priority recoverable claims elevated to immediate action. |
| There was inconsistency in payer policies concerning length and frequency of sessions and the process of prior authorization for continued therapy sessions. | Systematic follow-up schedule: once a week for claims within 30 to 60 days, twice a week for claims over 60 days, and daily contact for claims exceeding 90 days that have appeal opportunities. |
| Lack of a prioritization scheme for following up on ARs resulted in processing high value yet collectable claims together with non-collectable claims. | Submission of appeals with clinical information for denied claims and writing off uncollectible accounts to cleanse the aging report. |
| 40% of ARs were older than 90 days with no follow-up procedures defined. | Partnered with providers to enhance documentation standards, thereby lowering the denial rate for new claim denials. |
Key Deliverables & Impact
In five months, CureMed collected $285,000 out of a total amount of $420,000 in aged accounts receivable — an account receivable recovery rate of 68%. Average days in accounts receivable reduced from 68 days to 35 days — a 49% reduction. Denial rate of new accounts receivable claims dropped by 30%.
The Result
In CureMed’s AR process for recovery, strict follow-ups combined with root cause analyses ensure that future accumulations are prevented. The specialized AR services offered by CureMed are what set them apart from other companies offering generic billing processes for behavioral healthcare organizations.
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