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