- 1 can medical bills go to collections
- 2 Unpaid Medical Bills - Medical Collections under HIPAA
- 3 Do you have an unpaid medical bill? 3 things NOT to do.
can medical bills go to collections
You know the saying. an ounce of prevention is worth a pound of cure. Here are some things you can do on the front end so you don't have to spend so much time on the back end. They will help you with both insurance and patient collections.
Obtain complete demographic and insurance information from your patient.
Your receptionist should verify that your patients complete demographic forms in their entirety. This eliminates having to call the patient later. A copy of the insurance card is a must and a copy of the patient license is also a good idea.
Make it a policy to obtain your patient's social security number.
I have made this a separate tip just because it is so important. Patients are reluctant to give out their social security numbers for obvious security reasons. However, you need to educate the patient that many insurance companies still use the social security number as a means of identification. What if the insurance card is outdated? The social security number often serves as a substitute for the policy number.
In addition, collection agencies will tell you it is much easier to go after an unpaid patient balance when you have the social security number.
Reassure patients that your practice maintains the privacy of their medical information in accordance with HIPAA regulations, which includes their social security number.
At every patient encounter, ask if there has been an address or insurance change.
This is an important medical billing collection rule and it is not practiced often enough. These days, patients change insurance carriers frequently especially at the beginning of the year. Implementing this procedure avoids claim rebills and returned patient statements due to incorrect addresses. You would be surprised how much this helps with maintaining the cash flow of the practice.
Check eligibility and benefits on new patients.
When medical office staff tell me they don't have time to check eligibility and benefits, my response is, the time you don't take on the front end will be doubled on the back end in the collections process.
Some medical billing software offers automated eligibility that is integrated in their systems. While this feature isn't perfect yet, it can save you time.
You can also take advantage of the insurance company websites that are available to check benefits and eligibility when you can.
Naturally, this is easier said than done especially in a busy practice. But, I would do it where possible especially if the insurance information is unfamiliar or vague.
Collect copays and deductibles at the time of service.
This medical billing collection tip is mentioned in several places on this site because it is so important. If you have to mail a patient statement to collect a $5.00 copay, you've lost money. Posting a sign saying copays are due at the time of service is a good idea, but, your best asset is a receptionist that is cheerful but no nonsense about collecting money. Some patients can be pretty slippery characters.
I've seen some practices that charge a $5-$10 statement fee in addition to the copay if a statement has to be sent. Ask your local AMA office about implementing this practice.
Medical billing collection tips for insurance billing
Process your claims daily and use electronic billing and remittance for all carriers possible.
The sooner the insurance company pays you, the better. It is well known that the longer the time between the patient encounter and when the statement is sent, the less likely you will be paid.
In addition, if you are not checking eligibility and benefits, you want to find out as soon as possible what the insurance company is paying before the patient comes back for subsequent visits.
Electronic billing and remittance makes the turnaround time faster.
Delay claims billing at the beginning of each year.
Patients have new deductibles to meet at the beginning of the year. By holding claims back for a few weeks, deductibles may more likely be met so you can collect from the insurance company and not have to bill the patient and wait for the payment.
Do timely insurance follow-up.
This is where most practices fall down on the job because medical billing collection is so time consuming and, quite frankly, it can be a pain in the neck to do. It is also the easiest task to let fall through the cracks because there are so many other urgent tasks at hand.
As most good medical billers know, delays in follow-up can result in loss of payment due to lack of timely filing. What if you sent a claim to the wrong carrier? The error may be through no fault of your own. The carrier that you should have sent the claim to may have a 60-90 day timely filing limit.
If the timely filing period has expired, you can appeal the claim in writing and explain what happened. However, this process is time consuming and, in this scenario, the appeal will most likely be denied anyway. In the end, you will have to write off the balance because you cannot bill the patient.
Timely follow-up is one of the most important of all medical billing collection strategies. Insurance companies use a variety of bureaucratic stumbling blocks to avoid payment. You can usually overcome them if you follow-up on time.
Don't just rebill claims. Pick up the phone and call the carrier.
I see this happen a lot in medical offices. If you bill a claim and haven't received a payment or any notification from the insurance carrier, rebilling the same claim isn't going to help. Don't get me wrong. If you see an obvious error that you missed, by all means fix the mistake and rebill it as a corrected claim.
However, if you find nothing obviously wrong with the claim, simply rebilling it is usually a waste of time. There are exceptions to this, but for the most part, it's best to call the carrier.
Maybe there is a discrepancy in the patient name or date of birth. Perhaps the claim is pending co-ordination of benefits information from the patient. You won't find out this information without making that call.
You can also use insurance carrier websites for claim inquiries and e-mail your questions as well.
If you are having difficulty getting paid from an insurance company, involve your patient in the process.
I'll use a real life example to demonstrate:
The medical biller at an ophthalmology practice received a written authorization for a patient surgical procedure. She billed the insurance company for the procedure but it was denied for no authorization. Despite repeated phone calls to the insurance company, the claim remained unpaid.
At this point, I advised the medical biller to send a statement to the patient with a letter explaining the situation and ask the patient to call the insurance company to resolve the matter.
The provider may be contracted with the carrier, but where due diligence has been done, the patient is ultimately responsible for the bill.
This is an important medical billing collection rule: involving the patient can get the matter resolved more quickly. Insurance companies are much more responsive to patients than providers. If needed, offer to write a letter on the patient's behalf and have the patient sign it.
Generally patients feel it is the medical office's responsibility to collect from the insurance company, however, they need to be educated about this. Unless the carrier is Medicare or an HMO plan, insurance billing is a courtesy to the patient and they need to realize this.
Even if you are contracted with an HMO, as long as you have fulfilled your billing obligations, you should have no qualms about turning the matter over to the patient.
It is important to document all conversations with insurers including date, time, person's name, and conversation.
If your software includes this feature, use the cycle billing method to bill patient statements.
Most offices send out statements the same time each month. "Cycle billing" your statements is actually a better method to use if your software supports it. This functionality gives you the capability to print statements on a more timely basis.
For example, let's say you print your statements weekly. Your statement run will include new statements based on EOB postings since the last week plus all statements for unpaid transactions billed 30 days ago (or any number of days you desire.)
This is a good medical billing collection feature because it reduces the time between the patient encounter and the delivery of the statement, thus improving your chances of reimbursement.
Print remainder statements for every patient on the schedule each day.
This is a good idea if the medical biller has the time to do it. At a minimum, you could print the statements for patients with past due balances.
Attach the EOB to a statement if you anticipate difficulty collecting from the patient.
Some patients will call and complain no matter what, so I wouldn't go through the effort to do this all the time but occasionally it is a good idea if the insurance carrier pays an amount different than expected.
When it comes to patient collections, your policy should be 1,2,3, and you're out.
As a general rule, I send out three statements. If payment is not received by the third statement, I turn the account over to a collections agency.
I stamp the second statement past due. The third statement is stamped for collections action. You can ask your collection agency the proper wording to use. Generally, the warning will prompt the patient to pay.
After the given grace period, you can follow up with a phone call. A caution here. Due to HIPAA regulation, the patient has the right to request limitations on telephone messages. If you have to leave a message, you are say you are calling about a billing matter and ask the patient to return the call. This gets the point across without violating patient privacy. If you receive no response, then turn the account over to collections.
Be sure to flag the patient's account of the action taken. Most software has a note feature that will appear if the receptionist schedules a subsequent appointment for the delinquent patient.
If you have a large volume of patient statements, consider sending electronic statements.
Contact us to find out more about this great service.
If you follow these medical collection strategies, you are guaranteed to improve your cash flow and practice bottom line.
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Unpaid Medical Bills - Medical Collections under HIPAA
HIPAA may protect you when it comes to unpaid medical bills. The HIPAA law protects patient privacy and that includes third party debt collectors accessing your information.
Ah, the old unpaid medical bills. We all dread it, but most of us at some time will end up with unpaid medical bills. Sadly, many of us experience the result of the hospital or doctor placing the account with a collection agency with no notification.
Often times after an insurance payment, a doctor or hospital will simply assign the debt to a third party debt collector without ever billing the patient. There's no good reason why this happens other than poor accounting habits. A patient should have the right to be notified about a balance before it hits their credit reports as a collection account and ruins their credit rating.
Usually a patient will be told by the medical provider that they did bill them but that's not usually the case. Ambulance and emergency services are notorious for this. If you receive notification after the debt is assigned to a third party debt collector, stand your ground and insist on the debt being pulled back before you pay it.
Never "Simply" pay a collection agency for a medical bill
If you notice a medical bill has been reported to your credit reports by a collection agency then simply paying the debt is going to do little to improve your credit rating.
Unless you've already disputed (with good cause) with the credit bureaus and collection agency, paying the debt is going to do nothing more than turn it into a "paid collection". We cannot stress this enough. A "paid collection account" is the last resort. Ultimately, you want to negotiate complete deletion in exchange for paying it. Collection agencies, unlike original creditors, often remove accounts in exchange for payment.
With HIPAA, patients will have more privacy with 3rd Party Debt Collectors
Medical collections may have become a little more difficult to collect because of privacy rules with medical laws. The HIPAA privacy rule requires a "business associate" (collection agency or billing firm) to reasonably limit the amount of information disclosed for such purposes to the minimum necessary as well as to abide by reasonable requests for confidential communications.
This could be a loophole for debtors against collection agencies because collection employees often know less about their industry restrictions than does the debtor. This could lead to privacy and HIPAA violations - and eventually case law to support such violations.
If collection agency employees are not careful, they could lose out on collecting medical debts by inadvertently knowing too much about the debtor's medical condition. This will no doubt lead to many consumers seeking that the debts be pulled back by the medical provider to avoid potential suits against the provider.
Debtor's who know how to protect themselves will use this provision to threaten collectors and gain the upper hand in settling the medical debt without it hitting their credit reports. Basically, debtors who discover that the collector knows their diagnosis and treatment will threaten the agency that their privacy has been violated.
The agency, wanting to avoid unnecessary lawsuits will most likely agree to remove the negative entry on the consumer's credit report by agreeing to settle with such terms. The debtor will gain a clearer credit report by having the item removed rather than listed as "paid collection".
An unpaid medical bill on your credit reports can seriously affect your credit score. Medical bills, unpaid, are a negative rating in your credit history and unfortunately most of the time we dont know they're unpaid until they've landed in collections.
By that time, it makes less sense to simply pay it because the harm to your credit score has already happened. If this happens to you, you need to negotiate the credit rating with the bill collector before you pay or promise to pay. If you dont, you could be renewing the statute of limitations which determines how long the medical bill is collectible.
If you believe that your privacy pertaining to your medical history has been unlawfully accessed, you can file a HIPAA complaint. Click here to read all about filing a HIPAA (Health insurance portability accountability act) complaint. HIPAA prohibits any retaliation against you. Under HIPAA, an entity cannot retaliate against you for filing a complaint.
Do you have an unpaid medical bill? 3 things NOT to do.
Medical bills are inevitable. We find them in our mailbox after every surgery, treatment, or checkup and eventually learn to expect them, even granting them their very own spot on the living room coffee table. The fact that we get medical bills so regularly means we ought to know how to properly deal with them, lest we wish to risk creating more financial problems for ourselves down the road. By avoiding the following tendencies, you can keep your medical bills from becoming even more of a financial drain than they already are:
The Access Project, a nonprofit healthcare advocacy group, estimates that close to 80% of all medical bills contain errors. Therefore, if you’re paying your bills without looking them over beforehand, it is likely that you’re paying more than you ought to be. Common billing mistakes include double charging for a service, charging for services that weren’t received, and unbundling services that should have been charged for at a packaged rate; however, there are a myriad of other reasons why you could receive an inflated bill from your healthcare provider. With so much room for error, why wouldn’t you take the time to screen your bills for mistakes before paying them? It might be a hassle, but examining your bills for suspiciously high charges and haggling over them can actually spare your wallet quite a bit of shrinkage. In his publication Confessions of a Serial Haggler, President of Money Talks News Stacy Johnson cites a Consumer Reports survey saying that 93% of people who negotiated for a lower medical bill were successful. Additionally, Greg Voelm, the owner of a health care testing company in Sacramento, California and a 35-year veteran of the healthcare industry, says that these successful negotiations can lead to reductions of as much as 80%. These numbers indicate that any time devoted to deflating your bills likely won’t be lost for nothing.
You might be wondering, “What’s the worst thing an unpaid medical bill can do to you?” Well, more than you think. If a bill goes unpaid for too long it gets sent to a collection agency, and from there the “debt” can be reported to credit bureaus, meaning it will start to show up on your credit report. Because the primary determinant of credit scores is payment history, a credit report showing collections will significantly lower your score and make it impossible to get a loan without paying a large amount upfront or in interest. A 2014 research study conducted by the Consumer Financial Protection Bureau indicated that over 50% of all collections notices were the result of unpaid medical debt. Don’t become another statistic. Even if a debt is eventually paid off, it can take up to seven years for the collection to be dropped from your credit report. Until then your credit score will continue to be impacted and securing a mortgage, auto loan, or other private loan will remain a more tedious and costly endeavor. So for the sake of your future plans, it is probably best that you, unlike the more than 64 million Americans who had medical debt as of last year, keep your bills from going to collections in the first place.
As was mentioned, healthcare providers might incorrectly code patient information, leading to billing mistakes that must be sorted out by the patient and their provider. However, the situation can become even more complicated when insurance gets involved. Say you receive a treatment that your insurance is supposed to cover. As soon as you leave the hospital after treatment, someone will code all of your information and bill your insurance company for the cost of the treatment. If your information is incorrectly coded, it is possible that the insurance company will deny your claim, leaving you to foot the bill. To avoid paying for your treatment in full, you would have to file an appeal with the insurance company within a specified time frame. This is referred to as timely filing and it can vary anywhere from 30 days to 2 years depending on your insurance company’s policies. If you miss your window for timely filing, you are stuck paying for the full cost of your treatment. Thus, it is important to complete the appeal process well in advance of your insurance company’s timely filing deadline. Not doing so could force you to foot a whale of a bill that you have no business paying. Already guilty of these infractions? Reach out to the folks at DisputeBills.com by calling 888-622-2809 and receive your free bill review case consultation today.
Mariah is a Content Marketing Writer and student at the University of Chicago.