Review your billing, collections and account follow-up processes for a healthcare organization using this tool. This work program provides a structured approach for evaluating critical financial operations, ensuring compliance, minimizing revenue leakage, and optimizing accounts receivable management. This tool includes detailed guidance across key phases such as planning, fieldwork and reporting. It outlines steps for reviewing patient and insurance billing, adjustments, refunds, and aging reports.

Organizations are guided to conduct sample-based testing of receipts, denied claims, adjustments and refunds, ensuring proper authorization, compliance and accuracy. Additionally, the program emphasizes the importance of monitoring collection agency performance, validating contract terms, and ensuring timely follow-up on outstanding balances. By leveraging this work program, you can access best practices, standardized procedures and actionable insights to strengthen internal controls, improve cash flow management, and reduce financial risks in healthcare billing operations.

Notable points include:

• Daily Collection Reports: Users can test patient payments to ensure accurate posting to accounts, reducing errors and enhancing transparency.
• Denied Claims Analysis: Gain insights into denial reasons and follow-up procedures to minimize underpayments and improve claim recovery rates.
• Adjustments and Refunds Review: Evaluate samples for appropriateness and approval, ensuring compliance with policies and preventing unauthorized transactions.
• Aging Reports Testing: Assess follow-up efforts for accounts >360 days old to align with industry standards and improve resolution rates.