Registered Self pay and After Insurance Self Pay Billing
Given the volume of self pay accounts, and their relatively small balance in comparison to insurance receivables, many hospitals choose to work with an organization that specializes in the treatment of these accounts. This is an incredibly important choice, since the organization chosen will have direct contact with their patient. This provides the opportunity to enhance the patient’s perception of the provider, or detract from it. PMD is proud of the fact that we’ve been shown to enhance the patient billing process from the patient’s point of view.
It begins during the implementation meeting with the provider. We discuss initial statement options, and recommend our “two-up” notice as the first communication with the patient. It is a two part notice, which has an introduction letter with the hospital’s logo explaining the role of PMD. This is sent in the same envelope with a letter from PMD outlining the patient’s obligation along with confirmation of their primary, secondary and tertiary insurance, and how they can contact PMD regarding questions or to set up payment arrangements. (click here to view the Two-up notice).
If the patient does not respond to the initial notice, we begin our outbound telephone work. We attempt to contact the patient multiple times, and vary the time of day that we call. Since PMD is open until 8PM weekdays and from 9AM to 1PM on Saturday, we are able to call while most hospital’s business offices are closed. We continue to intersperse letters and calls until the account is resolved with a payment, or closed as “efforts exhausted”. (click here for the main timeline illustration)
During a contact with the patient, should the patient inform PMD that they have insurance which was not discovered by the hospital, we obtain the information necessary to submit the claim to the carrier. We call these accounts “discovered insurance accounts”. PMD will contact the carrier to verify that the patient has coverage for this date of service. We then provide this information to the provider to update their system and rebill the account to the correct carrier. The claim will be processed through their normal electronic claims submission vendor, which expedites payment to the provider. If the carrier does not pay the account within 30 days, PMD handles all insurance follow up on these discovered insurance accounts. (click here for the discovered insurance timeline).
Once payment arrangements which are consistent with hospital payment guidelines are established, PMD offers either guarantor billing or account specific billing. The patient will receive a monthly statement regarding the amount due, and should they become delinquent, the statement will indicate the amount which is considered past due. (click here for our monthly statement) The patient is given the opportunity to bring the account current however, if they do not we make one final contact, either by letter or telephone to let them know that we have no recourse but to return the account to the hospital for escalated attention.
Most hospitals today ask that we push their financial assistance program. We inform the patients in our notices of the availability of financial assistance, and if, during our conversation with the patient it becomes evident that financial assistance is needed, we coordinate the effort to have the patient complete the necessary application and provide completed applications to the hospital for their consideration.
It is also important to note that with the rise in registered self pay accounts, the same treatment program is not as effective as one tailored to these particular patients. Since they typically have limited means, we utilize a separate treatment timeline and unique letters intended to assist these people in identifying potential third party coverage. While overall recovery on registered self pay accounts still lags the recovery levels achieved on after insurance accounts, we believe our program maximizes the cash available from this difficult component of your accounts receivable.
The patients are directed to mail their payment to our lock box. This allows us to ACH your cash to you on a daily basis, along with a file of payments for posting. This reduces the efforts you need internally in your cash application area, and accelerates your access to cash. We invoice our clients at the end of the month for services rendered.
Standard performance reporting can be viewed in the secured marketing section of our website. Custom performance reports are available upon request at no charge.
PMD Insurance Department
Business offices
within medical facilities are frequently forced to spend
the majority of their time on the front end of claims
preparation and submission. Resources are limited internally
to follow up on outstanding claims once initial claims
leave the billing office. PMD is able to provide an
attractive service to actively follow up on open medical
claims where status is unknown. PMD’s sophisticated
software allows variable-sized batches of accounts to
be sorted and filtered into defined work queues, and
prioritized based on clients’ needs and requirements.
Our employees are fully trained and expected to resolve
claims with the least possible number of contacts per
account.
Due to our clients’ requests to keep all primary
Medicare claims internally, PMD has agreed to follow
up with all remaining insurance plans, including Medicare
secondary payers. This protects both the medical facility
and PMD from fraud/liability exposure relative to Medicare
billing.
PMD provides competitive rates based on a combination
of payer mix, age of accounts, average account balance,
and frequency of listed accounts. The following are
internal programs available to all medical facilities:
1. Discovered Insurance: PMD often finds that accounts
listed as self pay receivable in our payment center
have insurance that has been missed during the registration
process. We will: a) obtain complete correct information
from the patient/insured via phone or mail; b) will
verify coverage; c) and, will ensure proper update and
submission of claims directly from our clients’
software. We will monitor the account until either paid
or denied, and will resume billing the patient immediately
upon posting the insurance payment. If the information
provided by the patient is invalid, we will resume billing
the patient without delay. (click
here to view Discovered Insurance process)
2. Aged Insurance Receivable Resolution: Many facilities
list open insurance claims with PMD to ensure timely
adjudication. Once again, claims are worked with the
minimum required touches to either have the claim paid
or denied as quickly as possible. This in turn guarantees
prompt self pay billing of any residual balance due,
promoting positive patient relations. (click
here to view Aged Insurance Receivable Resolution process)
3. Medicare Secondary Filing and Follow Up:
PMD has the ability to provide
filing and follow up to Medicare Part A secondary payers.
This process guarantees and accelerates cash flow from payers
that are frequently ignored in traditional insurance
follow up processes due to small average account balances
after Medicare pays. This program is truly an easy economic
decision when presented with the model demonstrating
the process and end result of increased cash receipts.
4. Contract Management: Many claims are not paid per
contract by managed care payers and go uncontested.
PMD will become acutely involved in the interpretation
of our clients’ contracts, and will pursue payers
for the amount underpaid by insurance. Recovery results
in contractual reversals and increased accountability
for payers in a particular region to pay claims as agreed.
(click here to view
Contract Management process)
5. One Time Clean-Up Contract: Inevitably, computer
software conversions result in a backlog of aged insurance
receivable. PMD will review an aged trial balance along
with average account balance to determine whether a
mutual clean up effort is feasible for both parties.
(click here to view
Aged Insurance Receivable Resolution process)
6. Buy Back Program: PMD uses online verification software
to help identify and verify Medicare/Medicaid and/or
Third Party Liability coverage when self pay receivable
is listed. When Medicare (and some Medicaid, dependent
upon the facility and specific contract) is identified,
PMD will provide complete billing information to the
client in return for a small commission based on the
total balance of the account. Alternately, PMD assesses
a set fee per account when providing verified liability
coverage information (includes attorney contact information,
accident detail, etc.). If the account remains at PMD
to be monitored by the insurance department, commission
is based on the payment from the insurance company.
Additionally, once an account is listed with PMD, it
remains listed until either paid or denied. A Buy Back
fee is assessed if the client chooses to have the account
returned prior to resolution.
7. Ongoing Safety Net: Hospitals nationwide have a common
issue with their aged insurance receivable: insidious
accumulation of unresolved difficult accounts: a.k.a.,
cash. The accounts that get trapped in the resolution
process may be different in each facility, varying by:
payer, age, balance size, patient type, etc. PMD can
focus on prevention of restricted cash flow by allocating
staff specifically to this selection of accounts. With
PMD’s intercession, the claims can be resolved
and positive patient relations maintained as a result
of timely self pay billing.
PMD is very proud of the results achieved for our clients
relative to timely insurance claim resolution. The benefits
of utilizing PMD’s insurance receivable management
service are innumerable. Insurance receivable is reduced
resulting in lower DSO. Cash receipts increase and overall
cash flow is accelerated tremendously. Billing offices
have an opportunity to reallocate existing staff to
other internal areas requiring attention. Patient relations
are maintained or improved as a result of prompt insurance
claim settlement and clear communication from our skilled
representatives.
Please contact our office for additional information.
(click here for
contact information)
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