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Insurance Claims Resolution

Insurance Claims Resolution. Spend more time with patients, and less time worrying about receivables. With Insurance Carriers - Time is not on your side. 80% of all revenue for most medical practices comes from insurance claims filed electronically or manually.

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Insurance Claims Resolution

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  1. Insurance Claims Resolution Spend more time with patients,and less time worrying about receivables.

  2. With Insurance Carriers - Time is not on your side • 80% of all revenue for most medical practices comes from insurance claims filed electronically or manually. • Delays in payment cause frustration and restrict cash-flow. • GreenFlag Insurance Resolution Recoveryisan automated and revolutionary tool to assist in the rapid recovery and resolution of these claims.

  3. Why a delay in Claim Resolution Possible Causes: • Incorrect information • Missing codes, signature etc. • Money applied to deductible • Insurance checks released to patients • Insurance companies simply holding on to your money as long as possible • “Claims never received” • Claims held “in review”

  4. Internal Complications... • Rising internal recovery costs and FTE expenses • Continued depreciation of old claims • Coordination of benefits with primary or secondary provider • Billing staff tendency towards concentration on current claims after numerous attempts to recover older claims have failed • Continued restriction of cash-flow

  5. Common: One Phase Approach Typical In House ProceduresInternal Cost can be $20 - $35/claim • Most claims are paid • in the first 30-45 days. • Once past due, phone • calls, tracers, on-hold • time and FTE expense • increase with attempts • to resolve a claim. As claim ages: Cost to recover increases

  6. Recommended: Two-Phase Approach In-House Efforts GreenFlag Profit Recovery Takes Over • Submit claims as normal • Always have proof of timely filing • Month 2, follow up as usual on unpaid or unresponsive claims. • After 60 days, it becomes cost prohibitive with internal follow up. • Utilize the power of GreenFlag Profit Recovery to resolve your past-due claims for only $10.50 / claim. Focus your efforts on the first 45-60 days where the bulk of reimbursement is received…then let GreenFlag take over.

  7. Why GreenFlag Profit Recovery? • GreenFlag’s debtor offices and licenses in all 50 states allow us to use Insurance carrier by-laws typically requiring immediate response to our licensed third party contacts. • With a minimum of 5 touches per claim, our third party demand moves the responsibility for the claim from a clerk to a supervisor, who settles the claim more quickly and without the practice calling the carrier. • Our fixed fee of $10.50 per claim allows you to utilize this unique and cost-effective service on claims as early as 30-45 days past-due and resolve each outstanding claim within 90 days.

  8. As a collection agency, GreenFlag uses state by-laws which imposes timeline and consequence on the carriers, requiring them to resolve your outstanding claim.

  9. Claims You Can Submit: • Commercial Insurance • Managed Care Plans • HMOs • PPOs • Medicare • Workman's Compensation

  10. Remember: • It is not a matter of if insurance will pay, but when insurance will pay. • GreenFlag Profit Recovery reduces your internal costs and lowers response time, which works to reduce the age of your receivables.

  11. The Results Speak for Themselves • An Ohio ER Group assigned avg. 8 mth. old claims to Transworld totaling $587,000. We resolved and recovered 81% at a collection cost of only 1.9% and still posting payments. ROI: 52 to 1 • An Ohio Cardiovascular group assigned avg. 285+ day old claims to Transworld totaling $570,000. We resolved and recovered over 74% with an ROI of 38 to 1 even receiving interest payments from the carriers on the old claims.

  12. Results for:Children’s Emergency ServicesDayton, Ohio • ENHANCED FINANCIAL REPORT : CHILDRENS EMERGENCY SERVICES #3365U • Total Investment: $8,751.39 • Total # Purchased 1461 • Cost per Account: $6.00 • # Assigned: 1461 • Avg. Balance: $401.82 • Avg. Age of Accounts 11 months • Total Dollars Assigned: $587,059.75 • Less Mail Skips - $4,372.00 • Less Accounts Still Active - $22,171.01 • Net Dollars Assigned: $560,516.74 • Total Performance: $456,378.51 • Paid In Full $350,331.00 • Canceled (fully resolved) $460.00 • Suspended $69,789.04 • Partial Payments $35,798.47 • % Recovery Rate on Net $ Assigned 81.4% • % Recovery Rate on Total $ Assigned 78.3% • % Accounts Responding 91.51 % • Collection Cost as % Cost of Accounts Submitted Total Performance • 1.9% $8,751.39 $456,378.51 • ROI: 5214% • For Every $ invested, TSI returned: $52.15 • For Every Account, TSI returned: $312.37

  13. National Results: MGMA results for practices under that association: Insurance Resolution: Avg Claim Age: 4.7 months ROI: 153 to 1 Recovery Rate: 71.5% Cost to Collect: 0.7% (623 medical practices)

  14. Outcomes to Expect From Insurance Resolution Program: Get Paid Receive Fast Resolution to “Dirty Claims” Receive Denial to Convert to Patient Responsibility Goal of the Program: Get fast results from insurance carriers, increasing cash-flow Quicker response means addressing patient responsibility sooner.

  15. How Do You Benefit? • Using GreenFlag Profit Recovery at 45 - 60 days allows your staff to focus their attention and efforts on claims in the 0-60 day window. This reduces the number of claims reaching 90 days. • Quicker resolution of claims means patients get billed faster for their share of the balance, reducing the number of outstanding self-pay issues.

  16. Easy Process Process Insurance Resolution Program Within QHA Client Control Panel: Q Collect Tab

  17. Getting Started

  18. Choose Claims to View Date Range Plus 1 Parameter

  19. Click Send To Transworld Choose Claims to Send to Transworld

  20. Confirmation

  21. View Claims – Post Updates

  22. Update Claim Click ‘Update’ Tab On drop down – choose result Remaining Balance

  23. QHA and Transworld Systems thank you for attending our webinar. Question & Answer Session

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