There are many businesses who must deal with the cumbersome activity of having their money flows somewhat dictated by the insurance industry. If you fall into this category I hope I can pass along a few valuable tips to you.
Over the past 25 years I have found the most commonly used procedures which are usually in place as “standard actions” by those quite successful at collecting their hard earned pay from the insurance companies.
Understanding of the industry is the first thing / knowing what you are up against. This industry’s purpose is to assist those they represent in paying for services their enrollees have received / wish to receive from healthcare facilities, etc. In many cases they do provide this. However, this industry is also a money making activity and just as with the banking industry, the longer they can hold your funds the better they do financially!
We have all heard the following from time to time, “We’ve lost your claim”, “We need more documentation” “It is under review”. These are common hindrances to your cash flow.
I can factually say there are such cases in which you’ll need to provide better information, but you must face the fact that you’re up against a huge entity with a real purpose to make money. The “aggressiveness” they use to slow your reimbursements needs to be met, matched, or exceeded in your collection actions with them.
Attitude: The best personnel for this job are VERY aggressive in getting the money collected. They do not give up. They do not take “no” for an answer. Their attitude is: it’s OUR money; they have agreed to pay you and need to pay you FAST. The best collectors are constantly pounding the phones to those that owe them money (each insurance company), in order to get paid as fast as possible.
A wishy washy collector, one that is not too aggressive when needed, will continuously lose your money. You are the provider; you are also the Insurance Company’s client. You have the right to insist that they treat you well and pay you quickly!
Billing: You must have competently trained staff that have full understanding on how to bill ethically and swiftly. You will also need to have excellent billing software. There are many courses, workshops, on-line activities your staff can attend to receive billing training. But, training or not, their aggressiveness is the bottom line on your money.
The magnitude of effort used against you, meaning all the ways to ensure you are not paid fast, you must counter appropriately / overwhelm them with insistent aggressiveness on getting paid immediately. It is their “added time” you should pay close attention to. If you provide exactly what they need, and you heavily follow-up, you can increase your cash flow quite remarkably. (By the way, aggressiveness can be trained in with your staff, it is not necessarily all “inherent ability”. Sure some have it inherently, but training on how to be aggressive and exact actions to take in this area is available.)
Healthcare Practitioners: I learned years ago not to allow any direct healthcare practitioner, such as a Physical Therapist, to have anything to do with the money / billing. In many cases they can “give away the shop” due to their sympathetic & helpful ways with patients. This, of course also hinders your clinic from getting paid the full amounts it should be receiving for services rendered. Practitioners should not have decision-making authority when it comes to dismissing charges for services. You must be adamant with ensuring they document what treatment the patient really needed with full attention to delivery with the highest quality. Keep your finance department handling the money side of things and ensuring all treatments / services are billed fully and properly. Your practitioners are there to provide the utmost in service, not to give away services / your potential income! Keep them treating and completely off the money side of things.
These are some of the key basics.
I hope these tips have helped you.