Published on

Medical practice insurance resolution

Published in: Economy & Finance, Business
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide


  1. 1. Insurance Claims Resolution and Self-Pay Recovery Spend more time with patients, and less time worrying about receivables.
  2. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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