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Thread Topic: Collections
Topic Originator: Shelley
Post Date May 16, 2005 @ 8:22 PM
Collections


Shelley
May 16, 2005 @ 8:22 PM Reply  |  Email Friend   |  |Print  |  Top

Hi,

I work for a large company that does everything for a medical practice that sees around 4500 patients per month. Due to politics amongst the heads of the departments we have just been lumped with collections up to 120 days.

Unfortunately none of us know how to really work an account.

Any hints or tips that you can share woule be greatly appreciated.

Brenda Keene
May 16, 2005 @ 9:44 PM Reply  |  Email Friend   |  |Print  |  Top

Hi Shelley,

Wow! claims that are aged 120 days or more are sometimes difficult to collect...If you have a person(s) on board that is familiar with denials from all the various payors, I would assign this project to them. It will take a very knowledgeable person to collect for you...another alternative is to out-source to a billing center to clean-up your A/R...this is probably the better choice as the rebilling, follow-up and appeal process is intense.Which ever decision you make,do not wait to put your choice in action...many payors have timely filing limitss in their plans and also numbered days for appeals/rebills/.....Contact me if you need or want more specifics...smhs.brenda@sbcglobal.net

Ash
May 17, 2005 @ 10:41 AM Reply  |  Email Friend   |  |Print  |  Top

contact me on a1734@rediffmail.com.

thanks

prembiller
June 7, 2005 @ 11:46 AM Reply  |  Email Friend   |  |Print  |  Top

Shelly,

I request you to run an aged AR report for accounts that are over 120 days and bifurcate the accounts according to
1) insurance that makes quick payments
2) insurance with less filing limit

Once you have done the above, please start-reviewing accounts that have high dollar value.  If you have already received the rejections, please work on that.  If you have not received any type of rejections, I request you to blindly refile the claims for resubmission.  

Hope this helps.

Prem.

Ashish
June 8, 2005 @ 7:03 AM Reply  |  Email Friend   |  |Print  |  Top

nice info premmmmmmmm.

A. Simmons
June 14, 2005 @ 4:31 PM Reply  |  Email Friend   |  |Print  |  Top

My company can help do "clean up" short term if you like, and also train your staff on collections. Let me know.. I'll be glad to point you in the right direction..   Good Luck!

Shelley
June 28, 2005 @ 11:43 PM Reply  |  Email Friend   |  |Print  |  Top

Sorry perhaps I didn't make myself clear. We are a billing service that bills for an urgent care/workers comp facility. Our collections department was laid off with half of our billing department. Collections are then becoming our (the balance of the billing department) responsibility. We hand them over after 120 days to the collection agency.

The bosses/owners do not seem to care that we do not have any experience in collections and will not provide any training except the manual from the software that we use. Our jobs are on the line as daily we are told that we "are lucky to have a job". Most of the employees that are left are single mothers and need this job so we need to make this work.

Any suggestions for information on collecting on patient accounts and appeals for insurances. Is there also a protocol for working insurance accounts? HELPPPPP!

shelly
June 28, 2005 @ 11:44 PM Reply  |  Email Friend   |  |Print  |  Top

Sorry perhaps I didn't make myself clear. We are a billing service that bills for an urgent care/workers comp facility. Our collections department was laid off with half of our billing department. Collections are then becoming our (the balance of the billing department) responsibility. We hand them over after 120 days to the collection agency.

The bosses/owners do not seem to care that we do not have any experience in collections and will not provide any training except the manual from the software that we use. Our jobs are on the line as daily we are told that we "are lucky to have a job". Most of the employees that are left are single mothers and need this job so we need to make this work.

Any suggestions for information on collecting on patient accounts and appeals for insurances. Is there also a protocol for working insurance accounts? HELPPPPP!

Ashish
June 29, 2005 @ 8:05 AM Reply  |  Email Friend   |  |Print  |  Top

hi ,  it depends on different state laws, but most of times the average time is 8-12 months from date of service.

for more info contact me on a1734@rediffmail.com

Thanks
ashish

Leah
June 29, 2005 @ 9:16 AM Reply  |  Email Friend   |  |Print  |  Top

Shelley:

Collections is 98% common sense, 1% provider contract and 1% state law.

We cannot give you specific, step-by-step instructions becuase it is impossible for us to know why each specific claim is aging.  To complicate things, we don't know how your provider contracts read, we don't know what state you are in, etc. etc.

There is one way and only one way to work an aged account - find out why it isn't paid, and take the steps necessary to fix that.  To find out why it wasn't paid, look at the EOB.  Can't find an EOB, or the EOB makes no sense?  Call the payer.

That's it.

As far as which claim to work first - some people sort by largest to smallest, some sort by oldest to newest, some take all claims after a certain date and work those largest to smallest, and some take only the ones beyond a certain dollar amount and work those oldest to newest.

It's that simple.  Now get out there and start bringing that money in!  You can do it!

brian
June 29, 2005 @ 4:08 PM Reply  |  Email Friend   |  |Print  |  Top

Are you trying to collect insurance claims or self pay?  If it is insurance the only ways to handle a claim are to either refile it or call the insurance company.  If you are collecting self-pay, collect on the day of service.  You do not have that option being on the back side of the billing process.  I would think all that you can do is bill the patient with a statement, send a follow up letter, and then start making phone calls.  Check the legal requirements for avoiding harrasment in your state.

Kelly
August 24, 2005 @ 8:22 PM Reply  |  Email Friend   |  |Print  |  Top

Hi Brian
I have heard that the insurance companies are not helpful at all.

Are there any other places to find this information?

Thank you
Kelly

Masaood
October 18, 2005 @ 4:47 PM Reply  |  Email Friend   |  |Print  |  Top

You can outsource this to us. Our solution could be based on following steps:

"     Follow ups
"     Denial Management
o     Analysis of group codes, reason adjustment codes, and remarks codes
o     AAMZ Access Inc. would track denials, log what has been denied, why, how, and when the claim was filed to the greater levels of details.

The reasons could be:

"     Coding:  Denials caused by coding issues can include bundled codes, a diagnosis that is inconsistent with the procedure, and invalid codes or modifiers, etc.
"     Front Desk Issues: Registration, referral and authorization errors can contribute to denials.  These errors can include a subscriber who is not enrolled, an incorrect claims address and lack of referral or authorization, etc.
"     Billing: Denials caused by billing staff can include keying errors, credentialing issues (a provider is not enrolled), incorrect monies transfers, inaccurate payment postings, duplicate claims, untimely filing, problem in filing paper or electronic claims, etc.
"     Insurance Company: Denials caused by an insurance company can include lack of medical necessity, lost claims, requests for additional information for claim adjudication and other related issues.
ction taking
o     Submission of Claims (Electronic and Paper both)

Keeping in view electronic transactions standards (276/277) of HIPAA, AMZ Access Inc. team will get to the bottom of the claims status, and then will hit the claims accordingly which may include knowing:

"     Pre-adjudication (accepted/rejected claim status)
"     Claim pended for development (incorrect/incomplete claim(s) within adjudication process) or suspended claim(s) requesting additional information
"     Finalized claims. Further defined, finalized claims may have outcomes that include finalized rejected claim(s), finalized denied claim(s), etc.

Note: It should be kept in mind that denials out of medical necessity (mis-coding of claims) will be easy to handle and collect. The denials due to timely filing and incorrect or incomplete information can turn out to be more problematic, especially for claims of a year old or more.

For more info, contact us: infobilling@amzaccess.com or tel: 1-800-941-1269

masaood...amz aceess, inc.

Sue
July 18, 2006 @ 9:21 AM Reply  |  Email Friend   |  |Print  |  Top

I have had the joy of taking over several billing departments in similar shape. First  you have to get organized. You need to sort your A/R by payer first. Find the payers that have the shortest filing limits and check them first. You want to get rid of accounts with no hope. ie. if the filing limit is 90 days and you have no record of filing a claim and its now 120 days, there is no point in wasting your time. After you have to sorth the individual payer category from highest dollar down, these are all old so by service date doesn't matter at this point so much. Then its just a matter of plugging away. Start calling, because you have them organized by payer you can contact a payer by phone and just start running through the claims. Be careful how you ask questions and you can get info from the payer... i.e. If you have a denial for improper procedure code, ask "if I bill with 12345 will the claim be paid?" (be sure that the code you want to bill with is correct of course)don't just let them get away with saying...not covered.. press them to say why, and who is responsible... i.e. was it a non covered service that you can bill to the patient? If they say non covered based on your provider contract ask for the specific section to be sent to you..(sneaky way to get a copy of your contract if you can't find it)
The squeaky wheel gets the grease so to speak, have to hound the insurance companies sometimes.

Sue
July 18, 2006 @ 9:25 AM Reply  |  Email Friend   |  |Print  |  Top

Sorry, I reread your question and see that the claims aren't at 120 days yet, that does change things somewhat, after sorting by filing limit then you would want to sort by service date, make sure the ones that are teetering on the edge of the filing limit get done first, then work the highest dollar by service date

Steve Verno
July 26, 2006 @ 9:37 AM Reply  |  Email Friend   |  |Print  |  Top

I've been working A/R Recovery for years and I have a different manner on working them that works for me.  Understand that I am an aggressive person and my goal is to bring my provider money on these accounts.  My nickname is The Pitbull because I go after the accounts aggressively and I never give up.

Before you look at your A/R understand that if you have unpaid accounts at 120 days, you have a problem.  There are many reasons why these claims are unpaid:

1)  The insurance company will tell you they never received the claim.
2)  The patient is not one of their members.
3)  They cannot find the patient in their system
4)  The patient was not covered for the services you provided.
5)  The claim is in review.
6)  They are waiting for information from the member.
7)  The patient has other insurance that is primary.
8)  Payment was sent to the member

There is one word that can be used to eliminate these issues:
PREVENTION.

How do you prevent these problems?  You verify the information you received at the time of service.  Do not accept what the patient gives you as the truth.  If you verify before you provide the service, you will find out if the patient has coverage, you will find out if the benefits were terminated, you will find out if the patient has other coverage that is primary.  You need to speak to these patients about their claim and their financial responsibility BEFORE the patient is seen.  Patient education about financial responsibility will decrease your problems.  I know and speak from experience.  But, many practices say they don't have the time to do this.  I say this is BS because as a patient myself, not one of the visits I made to the various providers even spoke with me about my financial responsibility.  If I can wait for 2 hours in the waiting room, someone can verify my insurance info and spend about 10 minutes talking to me about my financial responsibility.   Did you know that with every visit, I saw a sign that said, "Payment is due at the time of service", yet not one of them even spent one minute to collect my co-pay.  Why have a sign if you won't do what you say?  How many practices have a financial plan?  How many practices that have them, show them to the patient.  I never saw one financial plan with any of my doctor visits.  When it comes to payment going to the patient, this may be because you are not contracted with the patient's insurance.  The way to prevent this is to collect 100% of the bill at the time of service.  You see, by asking for payment, the patient has the right to make an informed decision as to whether to continue with the care by paying for it or seeking care from a network provider.  You have an obligation to speak with the patient about this whenever you are not contracted with the patient's insurance carrier.

Again, prevention is the key to reduce your A/R problems.  But, that doesn't mean you won't have problems.

To keep accounts from getting to 120 days, you need to work them when they become 30 and 45 days old.  30 days for electronic claims and 45 days for paper claims.  You never want something to sit for 120 days or more.  The older the account, the more difficult it is to collect.  Understand that you are dealing with carrier time limits, State mandated time limits and the Doctrine of Laches.  The Doctrine of Laches goes back to the Middle Ages and what it means is that those that wait, lose their right to collect.

1)  Go through your system and locate any account where you are not contracted with the patient's health insurance.  With insurance companies where you are not contracted, immediately bill the patient.  The claim you sent was not your claim.  It was your patient's claim.  It is the patient that must resolve their claim issues.  The insurance company has no legal obligation to pay you as a non-contracted provider.  Their legal obligation is to pay the benefit to their member.  The patient is the one that owes you for the service they received.  So, bill the patient and collect from the patient.  Let them deal with their insurance company.  After all, they, not you, have appeals rights.

2)  Run a report of any Medicare accounts that are over 30 days old.
If they have not been paid or denied, resubmit them.  I normally reprint them on a CMS 1500 and send them to the CEO of the Medicare Carrier.  I explain that the claims were previously sent.  I attach a report showing when the claims were originally sent.  Again, By sending them to the CEO, I get results.

3)  Run a report of all Medicaid claims.  I do the same as with the Medicare claims.

4)  Run a report of any Medicaid HMO accounts that are over 30 days old.  I print these on a CMS 1500.  I send these to the State Medicaid regulatory authority with a complaint against the Medicaid HMO. The Medicaid HMO is obligated to pay these claims within the State's prompt pay laws.   I send a courtesy copy to the CEO of the Medicaid HMO.

5)  Run a report of any Medicare HMO accounts that are over 30 days old.  I also print these on a CMS 1500.  I send these with a complaint letter to the Regional CMS office and a courtesy copy is sent to the CEO of the HMO.

6)  Run a report of any Workers' Comp claims unpaid after 45 days.  I send them via Delivery Confirmation to the CEO of the Workers Comp Carrier.  I give them 30 days to pay.  If no payment is received, then I send the unpaid claim to my Workers' Comp regulatory authority with a copy of the delivery confirmation, and a complaint letter against the carrier.  A copy also goes to the CEO.  Now, about a week before payment is due, I call the carrier to remind them they have a week to pay the claim.  Usually I am told the claim is not on file.  I politely inform them I have a delivery confirmation that they received the claim and next week they can explain why they say the claim is not on file.

7)  I run a report of all auto accident claims.  I immediately bill the member.  It may be possible these were not reported to the carrier, the payment went to the patient, or they applied the amount to the deductible.

8)  For the remainder of the accounts, I run an Aging Report and look at all accounts that have money owed more than 30 days old.  This means the 60 day, 90 day, 120 day and 120+.  I identify the contracted carriers that owe me the most and I reprint all claims on CMS 1500.  I send them to the CEO of the carrier and explain that I do not appreciate my claims being unpaid after the time limits set in the contract.  I demand payment in 14 days, with interest, or I will consider their non-payment to be a breach of the agreement, I will terminate the contract and my provider will take them to court to obtain a judgement.  I will also send these accounts to my debt collection agency, listing the carrier as the debtor with instructions to list the carrier with the National Credit Reporting companies.  I also file a complaint with the State Office of Insurance Regulation to have the carrier investgated for a violation of the State's Prompt Payment laws.

I keep working the Aging Report, working my way down the carrier's, using the amount owed as my guide, because I work the high dolllars first, down to the lower dollars.

I run fresh aging reports weekly.  

By doing this, I have very little money outstanding at the 90 day aging.  

With uninsured patients or "self pay" patients who owe after their insurance paid, I send their accounts to collections within 30 days from having the account placed into patient responsibility.  The patient receives one statement only.  On the statement, it informs the patient that they will get this one statement and if payment is not received, the account is sent to my debt collection agency.  After all, why waste time sending 3 statements and a final notice letter.  If the patient ignores you after the first and second statement, the patient normally ignores the third statement and the final notice letter.  So we save tons of costs by just sending one.  

That's how I work A/R.  It may not work for others but it works for me.

jrffdc
May 14, 2007 @ 8:27 PM Reply  |  Email Friend   |  |Print  |  Top

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Susan
July 24, 2010 @ 12:34 AM Reply  |  Email Friend   |  |Print  |  Top

I have thousands of Family Practice claims that weren't appealed for years. EOBs lost, mybiller wasn't certified and wasn't following or appealing and now she left. I have templates for different appeals, but need to either outsource to a secure company who has certifed coders specilized in Family Practice codes or to a biller who specilizes in that. For old accounts I will pay minimum 8% to collect them. contact me at anny_750@yahoo.com if youthink you can do that. I'm in Dallas, TX.



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