This is a short presentation to the Bays Medical Society in Panama City Florida about improving collection of patient and insurance accounts in a private medical practice.
9. 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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11. 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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12. 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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13. No.3
Know the
Responsible Party
Always know who is ultimately responsible
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14. No.3
Know the
Responsible Party
• Patient?
• Insurance Company?
• Medicare?
• Medicaid?
• Assignment?
• Workers Compensation?
• Tortfeasor?
• Government Entity?
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15. No.4
Know the Contract
Participating Providers Should
Know Their Contracts Cold
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17. 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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18. No.5
Be Efficient
Simple to Say
Hard to Do
!
Don’t Give Up
Continuous Incremental Improvement
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19. No.6
Always Be Closing
Never Forget: They Have the Money
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20. 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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21. No. 7
Know Your Rights
Prompt Pay Act and Other Remedies
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22. 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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23. 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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24. No. 8
Find Alternatives
Other Sources of Possible Payment
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26. No. 9
Be Nice . . .
It really is a Relationship Business
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27. 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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28. No. 10
. . . until it is time NOT to
be Nice
Remember Patrick Swayze in Roadhouse
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29. 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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