Red Zone Efficiency:
Claims & Billing

Work every account every 30 days.

Jan-Care doesn't wait for a denial to start working an account. Once a claim reaches the 30-day mark, the team is checking payer websites, making calls, and investigating why it hasn't been paid.

Build payer-specific expertise.

Their follow-up staff is divided by payer type, allowing team members to become specialists in Medicare, Medicare Advantage, Medicaid, MCOs, commercial payers, private pay, and collections.

Know what you should be paid.

Jan-Care uses payer-specific rules to identify underpayments. Rachel's example was simple: if they're shorted even $25, the team knows it and determines whether an appeal, adjustment, or follow-up is needed.

Don't give up on coverage too early.

Rachel specifically discussed using Solutions Group to identify workers' compensation, third-party insurance, and auto coverage they otherwise may not be able to locate.

Automate the routine, but keep the data.

Asbel's benchmark is to automate roughly 90–95% of payment posting, while still posting at the line-item level so teams have the data needed to identify patterns, analyze payments, and support appeals.

Don't just fix denials. Find the root cause.

Separate controllable denials from true denials, look for patterns, and apply a process such as DMAIC: define, measure, analyze, improve, control.

Work the account before it gets old.

Asbel shared benchmarks of less than 10% of A/R over 90 days and less than 5% over 180 days, generally excluding self-pay. Rachel reinforced the point with Jan-Care's practice of touching accounts every 30 days.