How do payer behaviors differ across commercial, Medicare, and Medicaid AR?
Payer behaviors vary across commercial, Medicare, and Medicaid accounts receivable (AR). Commercial payers often delay reimbursements because of complex prior authorization and contract rules, while Medicare follows standardized but rigid processes with strict compliance checks. Medicaid typically involves slower payments, higher denial rates, and significant state-specific variability. These differences create unique AR challenges, requiring tailored […]
Why does aging alone fail to predict collectible AR?
Aging alone fails to predict collectible accounts receivable (AR) because the number of days outstanding does not reveal payer behavior, denial status, patient responsibility, or reconciliation errors. While aging buckets show how long balances have been pending, they ignore critical factors such as claim validity, payer rules, patient payment likelihood, and workflow efficiency, making aging […]
What is AR management in healthcare, and where does revenue most often get stuck?
AR (Accounts Receivable) management in healthcare is the process of tracking, collecting, and reconciling payments owed to providers from patients and payers, so that claims are processed, balances are collected, and cash flow remains healthy. Revenue most often gets stuck in AR due to claim denials, delayed payer reimbursements, uncollected patient balances, and breakdowns in […]