Steps to How Doctors and Healthcare Providers collect receivables from Health Insurance Plans:

The steps are simple, but the time it takes is draining on any practice. group.  Still none of it guarantees collecting the monies owed for healthcare providers.   One simple way of improving the bottom line of a business is to improve the collections.  

Typically when a healthcare plan does not pay a bill it follows this path:

1) Follow-up on Your Accounts

The medical office and their staff ensure timely and accurate payments by monitoring status of claims and contacting the payers to identify the current status of the claim and determine if anything is preventing the payer from making a payment, and correcting issues.

2) Appeal The Claim Denials

The office staff conducts a review of all denied claims and undertake actions to secure payment if possible or recommend and complete adjustments on accounts as warranted.

3) Appeal Out of Network Claim Denials and Negotiate

It takes much more work to apply for collections and collect from out of network payers.  Some businesses have inhouse staff expertise, with others don't.  This is typically when a revenue cycle management company is very helpful, to help collect the "reasonable and customary" rates. 

4) Understanding the Balances Owed to your Practice

Once all the efforts have been taken, i) collecting from insurance plans, ii) collection from out of network plans, iii) collecting from the patients directly; then a business must assess what is left over.  

5) Next - The Ultimate CLEANUP - Litigation

Once the billing experts have done their part and the accountants are staring at large balances of uncollected receivables, then the glaring question is what do you do?

To Understand what to expect next, go to Hard to Collect Health Plans.