I was excited as well as honored when asked to expand my in-service program to include Insurance collections and follow-up. Please see below for more details of the seminar. Specific Collection / Revenue Generating Seminars for the Provider’s Insurance collectors Our Exceptional Customer Service / Collection Seminars has included the provider’s insurance collectors, we are developing seminars specific for the provider’s insurance collection / revenue generating associates. A sample of the additional topics covered in our seminars:  5 W’s for collecting claims.  Call preparation.  Initiation of the call.  The follow-up.  Retorts.  Patient involvement – important to apply “Exceptional Customer Service” principles. Desired goals of the insurance revenue generating seminars:  Increase cash flow  Reduce “days”  Identify and reduce insurance carriers with slow payment history.  Reverse carrier’s elongated remittance habits or culture.  Build and re-new a robust, tenacious insurance revenue generating team.

1. Tenacious / Te·na·cious
1. Not easily pulled apart
a : persistent in maintaining, adhering to, or seeking something
valued or desired “a Tenacious advocate of civil rights” / “tenacious
negotiators”
2. Holding fast; Tenacious of old habits. pertinacious, persistent, stubborn,
or obstinate.
3. Stubborn or persistent: a Tenacious character

2. LETS START WITH A VERY IMPORTANT PART:
“OUR ATTITUDES”
 Be resolute.
 Be or become Goal driven, set:
Daily
Weekly
Monthly
 Set the example.
 Be a positive force within your organization.
 Show leadership
 Meet the challenges with a healthy, good, and positive attitude.
 Be happy, positive and up-beat…..ALL THE TIME.

3. LETS COME TO TERMS
In order to be successful, in any endeavor. We must realize what we
are and what our primary duty is and the envioment of those:
We are: Bill Collectors
And are on a: Collection floor
Yes, we have nice names, like:
 Patient Financial Representative
 Billing specialist
 Business Office
 Patient Financial Services or Revenue Management Office
In the end we are Collectors on a Collection floor. Create the
environment for success by having an understanding of what we
really do.

4. WHAT MAKES A GOOD COLLECTOR?
A good Collector doesn't need to beat, shout or intimidate the payer
into submitting payment.
It’s a conversation / negotiation leading to the payer into payment
submission.
A “journey” arriving to a mutual agreement and conclusion:
“Payment” for services.
Making the case that your bill / claim is important enough to be
paid NOW.
And if you can get them to do “favors”…you won.

5. BUILD ALLIES
Connections are good:
 Get to know your payers, not as “necessarily” as adversaries but allies.
 Give them what they need. Don’t hold back.
 Don’t play a back and forth till you end up with “belief polarization”.
 Positive manipulation is not evil or bad.
 Be considerate of their role, just attempt to trump yours.
 Have them know and be comfortable, trustworthy of you.
 DO Not betray the trust that was given.
 Be “connected” and have them want to do for you.

6. LETS SET OURSELVES UP FOR SUCCESS:
“PREPARATION”
The 5 W’s: The 5 “underpinning” questions that solidify payment claim conclusion.
“Who” are you speaking with
“What” are they doing with the claim
“When” is the claim going to be paid
“Where” is the claim in their process and verify where the payment is going.
“Why “ hasn’t the claim been paid?

7. CALL PREPARATION
Be Prepared:
 Know how the claim should be paid.
 Have the claim “up”.
 Review past notes.
 Gather any necessary additional paperwork.
 Be ready for the representative’s question
Closed End Answers – Yes & No - leave little room for retorts.

8. THE CALL
We can be Tenacious, while being friendly, polite, helpful. Most
important be “genuine.”
 ID yourself and the representative that your speaking with ask and
notate the encounter / call reference / ticket number.
 State the mission of your call.
I would like to check “payment status on the following claim” not
“status of the claim.” We’re looking for payment not status.
When is the expected date of payment?
Do not be timid about this.
 Date of ECS / date of claim transmission:
 Confirm: that it was Clean , Accepted and not “Rejected”
Be Ready for anything, don’t take NO for an answer.
Remember its like a tug of war: The insurance company prolongs payment
while we expedite payment.

9. THE RETORT
Don’t be shy, but do not be rude….this is very important. Your goal through your Tenacious
approach is to have the representative to some degree be an advocate for you.
 Why is the payment delayed? / delayed so extensively?
 Who is reviewing the claim? May I have the representative or supervisor of that dept?
 What is it that you need to conclude payment verification?
 Ask what their definitions of “in process” / “pending’ / “further review” and more
importantly time frames.
 What is your appeal process?
Time to bring the Calvary in.
When is it time to get the guarantor involved?
Mrs. Jones; “I’m calling to ask your assistance involving your healthcare claim with
Corpra Care Insurance. They have not denied nor made payment according to your
plan. All required claim / medical information has been submitted. To be perfectly
honest; we’re not sure why they have not paid nor denied the claim. We’re hoping that
you can assist us in that regard”.

10. THE FOLLOW-UP
 Bi-weekly follow-up on accounts greater than $10,000.00
 Review notes site encounter #
 Press (remain civil) for claim conclusion
 Site that all requested information was provide, give Encounter Number of
that conversation
Claim not on file
 Verify all information needed to re-file the claim.
 Request (do not ask) to send claim via fax.
 Request (do not ask) for the claim to be processed in a expeditious
manner. Site the original electronic transmission date as backup for
this request.
 Schedule a follow-up call to the representative immediately following
the claim transmittal. This is to verify that the rep has the claim in
their hands.
 Request (do not ask) if you can follow-up in the next day or so that
the claim is in processing. At this time you also request ETA of the
claim conclusion.
This is where your tenacious approach can pay off. Remember; you do
not have to be rude or overbearing. They owe your hospital this payment
for the services your facility put out.

11. CLAIM INFORMATION NEEDED FROM PATIENT
Do you believe it is appropriate get the patient involved?
 Exact information is imperative. Don’t waist time in continually
going back for more information.
 If necessary have a 3 way call with the patient.
 Once the carrier issues is “satisfied”, push for a payment date.

12. A BUM CLAIM
 Get it Corrected.
 If you don’t have the authority to corrected, have it done.
 Take it to your supervisor.
 Take it to the appropriate department.
 Solicit support from the payer (Insurance) to rectify the claim.

13. DON’T BE A “BURN-OUT”
 Be consistent.
 Pace yourself.
 Find know, and understand your niche, and speed.
 Better to be at a predictable level with smaller peaks and valleys
rather than a higher variance of peaks and valleys
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
Joe Moe
Jane Fane

14. NOTATION – NOTATION - NOTATION
Not enough words of importance can be said about notation.
 It qualifies.
 It hold all involved: ACCOUNTABLE….especially the Payer.
 It will empower you, your associates, and facility.
 It will put you in charge.
 And make you keener and more confident.