Medical practice insurance resolution

1. Insurance Claims Resolution
and Self-Pay Recovery
Spend more time with patients,
and less time worrying about receivables.

2. Transworld Systems Inc.
We’re in the business of profit recovery. We lead the
industry in providing medical practices with better
tools for recovering slow paying patient accounts and
expediting reimbursement from insurance companies.
I Last year, we recovered
$650 Million for our clients
I Over 32 years of experience
recovering slow-paying and
delinquent accounts
I Over 130 offices across
the United States
“Transworld gets credit for the highest recovery
rate in the industry.”
— Barron’s

3. Time is not on your side
I 80% of all revenue for most hospitals and medical
practices comes from insurance claims filed
electronically or manually
I Delays in payment cause
frustration and restrict
cash-flow
I GreenFlagSM Insurance
Resolution Recovery is a
revolutionary new tool to
assist in the rapid recovery
and resolution of these
claims

4. Delays in claim resolution?
Possible Causes:
I Incorrect information
I Missing codes, signature, etc.
I Money applied to deductible
I Insurance checks released to patients
I Insurance companies simply holding
on to your money as long as possible
I “Claims never received”
I Claims held in “Review”

5. Internal issues...
I Rising internal recovery costs and FTE expenses
I Continued depreciation of old claims
I Coordination of benefits with primary or
secondary provider
I Billing staff tendency towards concentration on
current claims after numerous attempts to recover
older claims have failed
I Continued restriction of cash-flow

6. Phase One
Typical In House Procedures
Internal Cost $20 – $27/claim
Day 1–30 31–60 61–90 91–120 121–150 151–180 181–210
HCFA Telephone Telephone Telephone Telephone Telephone Telephone
1500 or Calls or Calls or Calls or Calls or Calls or Calls or
UB92 Send Send Send Send Send Send
Sent Tracers Tracers Tracers Tracers Tracers Tracers
$0.50 $2.75 $2.75 $2.75 $2.75 $2.75 $2.75
$1.25 $1.25 $1.25 $1.25 $1.25 $1.25

7. Two-Phase Approach
Day 1–30 31–60 60 81 95 109 123
HCFA Telephone TSI’s TSI’s TSI’s TSI’s TSI’s
1500 or Calls First Second Third National Final
Demand Demand Demand Claims Demand
Manager
UB92 Refiling (30 day (State
Sent dispute statute
Send clause) reference)
Tracers
in-house in-house HIGHEST POSSIBLE RESOLUTION
1–3 4–6 LOWEST INTERNAL COST

8. Why GreenFlagSM
Profit Recovery?
I Insurance carrier by-laws and internal policies
typically require immediate response to our licensed
third party contracts.
I Our third party demand moves the responsibility for
the claim from a clerk to a supervisor, who settles the
claim more quickly.
I Our average fixed fee of less than $10.00 per claim
allows you to utilize this unique service on claims as
early as 30–45 days past-due.
I Insurance carriers will call your staff — effectively
reversing the line of communication.

9. Claims you can submit:
I Commercial Insurance
I Managed Care Plans
I HMO’s
I PPO’s
I Medicare
I Worker’s
Compensation

10. Remember:
I It is not a matter of if insurance will pay, but when
insurance will pay.
I GreenFlagSM Profit Recovery reduces your internal
costs and lowers
response time,
which works to
reduce the age of
your receivables.

11. The results speak
for themselves
I A surgical hospital
submitted 265 claims
totaling $622,000
to TSI. In 60 days
we recovered over
$400,000 at a total
cost of $2,120.
I A large non-profit hospital assigned 120+ day
old claims to TSI totaling $584,000 resolved and
recovered over $385,000 in 75 days.

12. Your practice will benefit
I Using GreenFlagSM Profit Recovery at 30–45 days
allows your staff to focus their attention and efforts
on claims in the 0–30 day window. This reduces
the number of claims reaching 60 days.
I Quicker resolution of claims
means patients get billed
faster for their share of
the balance, reducing the
number of outstanding
self-pay issues.
I Reduced internal costs.
I Happier staff.

13. In Summary:
I Improved Cash Flow
I Higher Recovery on
Insurance Claims
I Early Identification of
Patient Obligations
I Automated Program
Reduces Costs
I Effective National Presence