Finding a Cure for your Collections - Bays Medical Society

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This is a short presentation to the Bays Medical Society in Panama City Florida about improving collection of patient and insurance accounts in a private medical practice.

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Finding a Cure for your Collections - Bays Medical Society

  1. 1. Finding a Cure for your Collections Robert C. Jackson, Esq. Carla Appleman Thacker, Esq. HSMcLaw.com
  2. 2. Effective and Legal Methods HSMcLaw.com
  3. 3. Effective . . . but HSMcLaw.com
  4. 4. Ten Commandments of Collections HSMcLaw.com
  5. 5. Ten Commandments Suggestions for Collections HSMcLaw.com
  6. 6. Ten Commandments Suggestions Things You Might Want to Try But They Didn't Work For Me HSMcLaw.com
  7. 7. No. 1: Money Up Front “Show Me the Money” Best Way to Avoid Collection Problems is to Not Have to Collect HSMcLaw.com
  8. 8. Thank You Questions? HSMcLaw.com
  9. 9. No. 1: Money Up Front • Most probably do this in some manner • Trend in Industry • Concierge Practices • Generally nothing inherently illegal about this for a private medical practice (but talk to your lawyer) • Discounts for early or pre-pay (self pay only) HSMcLaw.com
  10. 10. No.2 Eliminate Surprises No One Likes Unpleasant Surprises HSMcLaw.com
  11. 11. No.2 Eliminate Surprises • Pre-Procedure Counseling • Clear, Transparent, and Common Sense Pricing • Pre-Authorization of Insurance (in record) • Manage Patient Expectations • Don’t be Afraid to address money issues upfront HSMcLaw.com
  12. 12. No.2 Eliminate Surprises • Some Practices Are Really Good At This • No insurance or no coverage practices • Cosmetic, Weight Loss, Infertility • Payment Plans • Get “Buy in” From the Patient Up Front HSMcLaw.com
  13. 13. No.3 Know the Responsible Party Always know who is ultimately responsible HSMcLaw.com
  14. 14. No.3 Know the Responsible Party • Patient? • Insurance Company? • Medicare? • Medicaid? • Assignment? • Workers Compensation? • Tortfeasor? • Government Entity? HSMcLaw.com
  15. 15. No.4 Know the Contract Participating Providers Should Know Their Contracts Cold HSMcLaw.com
  16. 16. No.5 Be Efficient Use Systems to Stay on Top of Claims HSMcLaw.com
  17. 17. No.5 Be Efficient Claim Like a Fish Out of Water ! Fillet it, or Let it Go ! But don’t let it die gasping for air HSMcLaw.com
  18. 18. No.5 Be Efficient Simple to Say Hard to Do ! Don’t Give Up Continuous Incremental Improvement HSMcLaw.com
  19. 19. No.6 Always Be Closing Never Forget: They Have the Money HSMcLaw.com
  20. 20. No.6 Always Be Closing • Document! Document! Document! • Answer all questions • Hit the books (contracts, coding, etc . . . ) • Get names, numbers; Confirm requirements • Fight bureaucracy with responsibility and accountability • Don't not close an interaction without knowing what needs to be done by whom to get you paid. • Remember: They have the money HSMcLaw.com
  21. 21. No. 7 Know Your Rights Prompt Pay Act and Other Remedies HSMcLaw.com
  22. 22. No. 7 Know Your Rights • Florida Statues Sections 627.6131 and 641.3155 (add to correspondence) • http://www.myfloridacfo.com/division/consumers/medicalprovider/ TimelyClaimsProcessing.htm#.U_Qkg0uaZG4 • Health Plan Claim Dispute Resolution Program (Maximus) • Contractual Dispute Resolution • Medicare • ERISA HSMcLaw.com
  23. 23. No. 7 Know Your Rights All Electronically Submitted Claims • A health insurer must acknowledge receipt of an electronic filed claim within 24 hours after receipt of the claim. • Within 20 days after receipt of the claim, a health insurer must pay or notify the provider or designee if a claim is denied or contested. • A provider must submit additional information regarding the denied or contested claim within 35 days after receipt of the notification. • An insurer must pay or deny a claim within 90 days after receipt of the claim. Failure to pay or deny a claim within 120 days after receipt of claim creates an uncontestable obligation to pay the claim. ! Non-electronically Submitted Claims • A health insurer must acknowledge receipt of the claim within 15 days after receipt of the claim. • Within 40 days after receipt of the claim, a health insurer must pay the claim or notify a provider or designee if a claim is denied or contested. • A provider must submit additional information or documentation within 35 days after receipt of the notification. • A claim must be paid or denied within 120 days after receipt of the claim. Failure to pay or deny a claim within 140 days after receipt creates an uncontestable obligation to pay the claim. An overdue payment of a claim bears simple interest of 12 percent per year on claims. HSMcLaw.com
  24. 24. No. 8 Find Alternatives Other Sources of Possible Payment HSMcLaw.com
  25. 25. No. 8 Find Alternatives • Workers Compensation • PIP • Other sources of $$$$ • Tortfeasor • Estate • COBRA • Guardianships • Charity / Grants HSMcLaw.com
  26. 26. No. 9 Be Nice . . . It really is a Relationship Business HSMcLaw.com
  27. 27. No. 9 Be Nice . . . • This may be the Most Effective Tip • People will do things for you, especially bureaucrats • Focus on a few contacts and companies • Good companies and people want to get you paid • Eliminate bad actors HSMcLaw.com
  28. 28. No. 10 . . . until it is time NOT to be Nice Remember Patrick Swayze in Roadhouse HSMcLaw.com
  29. 29. No. 10 . . . until it is time NOT to be Nice • Legal Remedies • Collection Companies • Credit Report Hits • Complaints to Government Agencies HSMcLaw.com

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