How an effective WFM tool can save millions of dollars of AR in Medical Billing

Wednesday, October 19, 2016 8:06
Posted in category Account receivables
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e-care workforce management tool

Changing Payment Methods:

At this time of US healthcare evolving into different payment methods and moving from traditional Fee for Service payments, it is important for billing companies to ensure that their end clients get paid all their claims either by insurance payments or patients to maximize their revenue and reduce write off of unpaid claims due to passing appeal limit and timely filing limits.

On the other hand, Billing companies also need to ensure that every claim is paid the correct amount as per the Fee Schedule, Contracted rate, UCR etc. and are not underpaid. Underpayments and failure to appeal on underpayments cause significant revenue loss to providers.

In order to achieve the above, a very strong Accounts Receivable management team is needed who follow up on every claim till they get paid in full. However due to resources crunch, time challenges and efficiency uses, lot of money is lost by the provider when AR follow up or Appeals are not done timely and effectively.

Even the strongest AR teams of AR follow up experts or denial management experts tend to focus on high dollar claims and since practice has a large volume of low dollar claims, several claims pass through the crack which either sit in the AR inventory and inflate AR days or gets written off. Writing off such claims makes the AR days look healthy but still does not support the practices cash flow.


AR Management Team – Automation:

A robust and technically advanced AR Work Flow Management tool (WFM) helps the AR team to automatically prioritize and work on accounts on various parameters such as Insurance filing limit, appeal limit, dollar value etc. It also helps the AR team to trend and identify global issues by insurance, by provider, by procedure or by denial which helps the AR team to address multiple claims at the same time leading to increased productivity and quality.

It also helps the Billing company with dashboards with different metrics like Unworked claims, number of touches to resolve a claim, claims that are missed follow up on due dates, break up of AR issues by different categories like Coding, Credentialing, Billing etc. which helps to identify the issues across different departments and provide training, corrective and preventive actions to ensure maximum reimbursement.

Most importantly the WFM tool provides Clean claim rate (First pass ratio), payments realized through AR efforts (follow up calls, Telephonic/ paper appeals) and through patient statements. Thus an effective AR WFM tool will ensure that no claims are passing through the timely filing and appeal limit deadlines which are made stringent by the insurance companies.


eWORKS – The Solution!

eworks wfm-tool-ecare

e-care’s AR WFM tool “eWORKS” is a robust and sophisticated tool which helps all e-care’s  clients to enhance their cash flow and reduce AR days significantly. It is developed by e-care’s technically skilled team of Subject Matter experts who have 20+ years of experience in AR and Revenue Cycle Management along with extremely qualified software professionals. eWORKS provides state of the art technology for the Billing companies in turn to their end clients, providers to get maximize collections for the charges billing to insurance carriers and patients in a timely manner.

To know more about e-care and eWORKS, call us at 813-666-0028 or email us at or visit our website

Medicare Revalidation process for Providers and Suppliers

Friday, August 12, 2016 10:02
Posted in category Credentialing services
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Medicare Revalidation process for Providers and Suppliers


CMS has defined time frame for providers and suppliers to send their re-validation application to the Medicare Administrative Contractors (MAC) to be in compliance with provider enrollment requirements. The due dates generally fall on the last day of the month, for example, 30th June, 31st July which is determined based on the last successful re-validation or initial enrollment date. Read the rest of this entry »

How does Health Insurance Impact your Tax this Year?

Friday, March 13, 2015 5:44
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How does Health Insurance Impact your Tax this Year


The ’Individual Mandate’, one of the Affordable Care Act reforms, has been the hot topic in the US healthcare space lately. This policy has made buying health insurance mandatory for those people who are uninsured. The ultimate goal of this policy is to promote a healthier nation; however there is downside to it. Read the rest of this entry »

Preventative Healthcare Gets Its Importance In Obamacare

Monday, December 22, 2014 5:08
Posted in category Obamacare
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‘Prevention is better than cure’ – Recognizing the truth in this adage, ‘Obamacare’ has brought in the preventative healthcare services to create a healthy tomorrow. Heart disease, stroke, cancer, chronic low respiratory disease and accidental injuries are considered as the five main causes for the increased mortality rate in the US. Read the rest of this entry »

CMS’ Health Surveys to strengthen PQRS

Wednesday, December 10, 2014 10:55

Consumer Assessment of Healthcare Providers and Systems:

This is a survey developed by CMS, to gain feedback from patients and their relatives about experiences with and ratings of their healthcare providers and plans. The survey includes hospitals, home health agencies, Doctors (single and groups), and health drug plans.  The survey results are publicly shared by CMS, so Providers may have an impact due to ratings, because it is the feedback of the patients. Read the rest of this entry »

Ebola Scare in the US!

Wednesday, October 29, 2014 5:57
Posted in category Medical Billing
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The growing panic among the US citizens over the Ebola virus has become the recent buzz in the country. The US Centers for Disease Control and Prevention (CDC, Atlanta) has estimated that by August 2014, approximately 68 Ebola scares were handled by US healthcare facilities and state labs. The numbers have doubled and tripled in the months of September and October. The latest news is that the deadly virus could reach Britain and France by the end of this month (October). The approximate number of people infected so far by this rapidly spreading virus is 7,200. Let us take a look at when and where it all started and how scientists and healthcare workers are struggling to contain a full-fledged outbreak: Read the rest of this entry »

Why is India a Better Offshore Destination?

Monday, March 24, 2014 6:31

Why is India a Better Offshore Destination


Lately, outsourcing medical billing has become a common practice in the US healthcare domain. To streamline the medical billing activities of a customer, US medical billing companies partner with offshore medical billing companies located in various countries, including India. Read the rest of this entry »

It is Insurance Eligibility Verification time!

Friday, February 28, 2014 7:45

It is Insurance Eligibility Verification time


The effort taken by most healthcare entities in minimizing claim denials has become remarkable in the recent times. They pay more attention in documenting patient demographics, entering ICD & CPT codes, updating current charges, performing regular AR follow-up and more. However, their claims still get denied by the Payer. Read the rest of this entry »

Pros and Cons of Offshore Medical Billing

Monday, February 17, 2014 5:46

We all know that Healthcare Providers are trying their best to sustain their practice, especially after the  new healthcare reforms. It is the same scenario with US based healthcare outsourcing companies as well. Since their end-clients are facing the changes, the healthcare outsourcing companies also face the same concerns. Read the rest of this entry »

Benefits of ERAs/EFTs

Friday, February 7, 2014 10:11

Benefits of ERA and EFT


The introduction of ERAs (Electronic Remittance Advice) and EFTs (Electronic Funds Transfer) created a revolutionary change in the healthcare billing domain by replacing traditional, paper-based EOBs (Explanation of Benefits). Read the rest of this entry »