What is AR?

AR stands for "Account Receivable" and it is a part of the "Medical billing process" and "Revenue cycle management (RCM)" of the United State of America & prior to understanding AR, it is necessary to understand the Medical billing process & RCM, so let's start understanding these two processes.

In the United State of America, when a patient visits a doctor for a check-up or treatment then he/she takes the service but does not pay the doctor if has an insurance policy. He/She provides policy details to the doctor and the doctor gets the money from the insurance company. To get the payment for the services rendered to the patient, doctors need to bill the service to the insurance company in the claim form that includes patient information, provider information, service performed in the form of CPT, and Diagnosis code with the billed amount. Based on the CPT and diagnosis code, the insurance company makes the payment for a certain amount if there is no issue. This entire process looks simple but it has a highly complex process behind the scenes. In medical billing, the doctor is also known as the "Provider".

The process of generating claims, submitting them to insurance, and following up on claims to get the resolution is known as the Medical billing process.

RCM is responsible for taking care of the entire process starting from the patient appointment with the doctor to the resolution of a claim. It includes various steps that help to understand the entire complex process of taking care behind the scenes.

To understand each step of RCM Click Here. Please go through it.

Hopefully after going through the RCM steps, now at least you have an overall idea about how this cycle helps to generate claims and helps doctors to get reimbursement for the service rendered to patients. You would also observe that AR comes at the end of the cycle when a particular service is not paid. So, AR is responsible to analyze the claim, take the follow up with insurance, and based on the information received by the insurance company or analysis, taking the most suitable action that would move a claim toward resolution.

When taking a follow-up with the insurance company, AR comes across various scenarios and denials. There is a number of scenarios & denials already defined with appropriate questions to gather accurate information from an insurance company that would help AR to take the next most appropriate action. To have knowledge of these scenarios, you would need to understand each AR scenario. It has a long list that could create confusion in your mind. So, go through one scenario at a time and take time to understand it. Also always try to connect each scenario with RCM steps since the entire scenarios and actions are based on RCM. Click Here to learn AR Scenarios.

It is difficult to understand these terms, scenarios, and denials if you are not working as an AR, but we'll try to explain these terms in a simple way that would give you confidence when you will start as an AR and will help you to grow as an AR.

There are also various tools, terminologies, and rules in medical billing. Some are based on insurance or denials and all this information you will find under the "MORE" option in the menu bar. 

We have also listed down the phone numbers of the insurance companies in the "Insurance Phone#" option to connect with them and get the required information. For Medicare insurance, obtaining claim status, eligibility, or connecting with a rep is a bit complicated but once you understand it then you can work easily. We have put all the important information under the "Medicare Phone#/Forms" option.

For some insurances, it is not always necessary to make a call to the insurance to obtain claim status and eligibility. Their websites are helpful to obtain all the required information. We have listed down a few insurances with links in the "Websites" tab where you can directly register to get the status. There are few websites where registration is not required and status can be obtained directly. There are a lot more websites available based on insurance, you can get the web portal information from the insurance rep and try to register. Sometimes, it is not always necessary that you would be able to register yourself but need client help, so you can ask the client to get access.

Hopefully, above all information will help you to understand AR work and be helpful to start up your AR career. So, keep following our website, subscribe to us to get updates on our new posts, and contact us for any questions & clarifications.