A/R recovery for healthcare practices

Realizing net collections to their fullest

Many healthcare providers find their practice or business generating expected or reasonable monthly charges but the actual net collections are not being realized to their fullest.

Within six months to a year, unless specific active follow up on the current billings is initiated, it is common to find a provider with excessive amounts in A/R that are greater than 180 days outstanding.

The billing staff of the provider are continuing to process new claims but generally do not have the time or resources required to devote to collecting on the older accounts. The addition of one or more "temporary" collectors only partially solves the problem.

Usually the volume of outstanding claims and the time it takes to research, correct, appeal, and/or re-file the claims will take much longer than anticipated. A limited number of staff devoted to this task will not be able to accomplish the goal, which is to substantially reduce/eliminate the outstanding A/R and collect as much money as possible in a short period of time.

The program offered by MGSI overcomes the problems that traditionally hinder collection efforts by the individual providers. MGSI pursues these accounts by assigning a full team of individuals to "blitz" them.

We utilize experienced, well-trained individuals in the billing process as our collectors. Most of these employees are college educated. They perform their work in three phases:

Phase I - Initial evaluation
This phase involves identification and analysis of the claims listed on the A/R Aging Report. The team will review the provider's write-off policy from which we will identify which claims need to be written off. Additional claims may be identified as write-off claims once the analysis of filing limits is conducted in Phase Two below.

During this Phase, the remaining claims following the initial write-off will be sorted by value by carrier to estimate the total potential recovery.

Phase II - Analysis and prioritizing
Experienced analysts initiate this phase by identifying the various issues for claims that are marked as uncollectibles or for claims where the carrier has under paid and appropriate actions should be initiated to pursue the remaining valance.

Provider verification is done by the call center to the major insurance carriers to identify and validate the Tax ID number, Pin numbers, and Group number s for the providers.

The filing/appeal limits of the major carries will be checked and also the "claims submission address" will be checked for the claims to reach the correct processing unit. The team also confirms that "clean claims" will be reimbursed as per the contracted time.

These verifications are done on claims that are reimbursed Fee for Service and also for case rate billing. If the claims are capitated, adjustments will be taken as appropriate so that they do not falsely inflate the receivable amounts on the books.

Claims that have crossed the carrier filing limits will be identified and the reasons will be analyzed and validated.

Following the above steps, all remaining claims are again sorted by value and carrier.

Phase III - Collections
Based on the analysis team's findings, the claims that are identified to be within the filing limit of the carrier are re-filed after verifying all the necessary parameters such as claims processing address and the other billing rules.

With Medicare claims, our team checks their status before submitting them to the carrier. Submission of duplicate claims becomes a compliance issue and so to avoid this, claims to the Federal carriers are checked before submission.

If the database has a large volume of non-Federal claims, it may not be possible to check the claims status of all the claims. In this case, our team will take a sample of claims outstanding to different carriers and check the status of the sample claims to generate a summary. Depending upon the volume of claims not found on the file in the carrier's system, the team may find it advisable to submit all of the outstanding claims to the carrier to be processed.

Claims that have exceeded the filing limit of the carrier as well as the claims that appear to be underpaid by the carrier, are appealed with the necessary supporting documents. Appeal procedures vary widely depending on the plan, carrier and state. These procedures are collected and applied on claims that are being appealed.

We will transmit the claims electronically directly to the carriers wherever possible and for the other carriers, claims are forwarded through clearing houses and aggressively followed up with the carrier for confirmation.

After completing all the above and posting cash to the outstanding claims, patient bills are generated as per the client guidelines and then followed up with the patients for payments.

Summary
The ultimate success of our Cash Acceleration Program is dependent upon several factors:

Certainly the completeness and accuracy of the account data provided is important. MGSI provides the systems, expertise, and resources necessary to perform a comprehensive collection effort. However, the more successful programs also have received a high level of support and cooperation from the provider's office.

Many insurance carriers will require additional documentation to be submitted with the claims before they will process for payment. This documentation is usually contained in medical records to which MGSI does not have access. The designation of a key individual(s) in the provider's office through whom MGSI's staff may work to obtain the necessary documentation or information will enhance the collection process significantly.

Because MGSI is already in the field of providing medical billing services, our knowledge of billing rules and processes greatly enhances our ability to also conduct successful Cash Recovery Programs.

Further information
For more information on the this service and how it can benefit your practice call toll free at 1.877.896.6474 or e-mail info@mgsionline.com.

A/R recovery - collecting as much money as possible in the shortest period of time