Steps to How Doctors and Healthcare Providers collect 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?
Solution to Collecting from Health Insurance Companies:
At Mirza Healthcare Law Partners, we go after the health insurance plans to collect those monies. We gather your data, summarize it, make demands on the insurance companies to pay; and if they don't, we sue them. Literally file a lawsuit! (some contracts require filing for arbitrations, but its a very similar process).
To Understand what to expect next, go to Hard to Collect Health Plans.
In the end, we go to bat for our healthcare providers, and we do it on a contingency fee basis - meaning if the client does not collect, we don't collect fees.