Insurance Accounts Receivable

Insurance accounts receivable (A/R) refers to the outstanding claims submitted to insurance payers that are awaiting payment. It encompasses the entire process from claim generation to final reimbursement.

Claims are generated in the 837 format and submitted with all required patient, diagnosis, and procedure details. They are then tracked through the revenue cycle to ensure timely processing and payment.

Financial teams investigate the denial reasons, such as coding errors or missing documentation, correct the issues, and either resubmit the claims or initiate the appeals process.

Payments are posted upon receipt, including both primary and secondary payments. They are reconciled with electronic remittance advice (ERA) to ensure accuracy and identify any discrepancies.

Aging analysis categorizes outstanding claims based on how long they’ve been unpaid (e.g., 30, 60, 90 days). It helps teams prioritize follow-ups and reduce A/R days.

Payment variance analysis compares expected and actual payments. Discrepancies are investigated and resolved, while approved write-offs are documented based on contractual or regulatory guidelines.

Revenue cycle management software is used to streamline claims processing, automate payment posting, analyze performance, and generate reports on key A/R metrics and trends.