Finding a Cure for your Collections - Bays Medical Society
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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.

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 Presentation Transcript

  • 1. Finding a Cure for your Collections Robert C. Jackson, Esq. Carla Appleman Thacker, Esq. HSMcLaw.com
  • 2. Effective and Legal Methods HSMcLaw.com
  • 3. Effective . . . but HSMcLaw.com
  • 4. Ten Commandments of Collections HSMcLaw.com
  • 5. Ten Commandments Suggestions for Collections HSMcLaw.com
  • 6. Ten Commandments Suggestions Things You Might Want to Try But They Didn't Work For Me HSMcLaw.com
  • 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. Thank You Questions? HSMcLaw.com
  • 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. No.2 Eliminate Surprises No One Likes Unpleasant Surprises HSMcLaw.com
  • 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. 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. No.3 Know the Responsible Party Always know who is ultimately responsible HSMcLaw.com
  • 14. No.3 Know the Responsible Party • Patient? • Insurance Company? • Medicare? • Medicaid? • Assignment? • Workers Compensation? • Tortfeasor? • Government Entity? HSMcLaw.com
  • 15. No.4 Know the Contract Participating Providers Should Know Their Contracts Cold HSMcLaw.com
  • 16. No.5 Be Efficient Use Systems to Stay on Top of Claims HSMcLaw.com
  • 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. No.5 Be Efficient Simple to Say Hard to Do ! Don’t Give Up Continuous Incremental Improvement HSMcLaw.com
  • 19. No.6 Always Be Closing Never Forget: They Have the Money HSMcLaw.com
  • 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. No. 7 Know Your Rights Prompt Pay Act and Other Remedies HSMcLaw.com
  • 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. 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. No. 8 Find Alternatives Other Sources of Possible Payment HSMcLaw.com
  • 25. No. 8 Find Alternatives • Workers Compensation • PIP • Other sources of $$$$ • Tortfeasor • Estate • COBRA • Guardianships • Charity / Grants HSMcLaw.com
  • 26. No. 9 Be Nice . . . It really is a Relationship Business HSMcLaw.com
  • 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. No. 10 . . . until it is time NOT to be Nice Remember Patrick Swayze in Roadhouse HSMcLaw.com
  • 29. No. 10 . . . until it is time NOT to be Nice • Legal Remedies • Collection Companies • Credit Report Hits • Complaints to Government Agencies HSMcLaw.com