Alternative for Medical Facilities Facing Financial Difficulties
Over the summer, many hospitals and medical centers either downsized, filed for bankruptcy, or closed their doors. In some cases, these facilities were the only ones serving their communities for miles around, as in the case of the Cochise Regional Hospital in Douglas, AZ.
Rural hospitals are having the most trouble staying afloat, but the problem is pervasive throughout the health system. It seems like there’s a new facility closing announcement in Modern Healthcare magazine at least once a month these days.
What’s going on? Often, insurance companies are refusing to pay these facilities what they are owed. And often, our specialists here at Claims Resolutions wince a little bit when we hear these stories. If we’d only known the facility was in trouble, we might have been able to help before the big closure announcement.
Paperwork problems: the number one reason hospitals don’t get paid.
Insurance companies don’t want to pay facilities a dime. They want to take premiums from customers, then go brag about their awesome profits on Wall Street.
However, insurance companies are legally required to pay valid claims. How do they get around this requirement? By using any excuse whatsoever to deny or reject a claim. This includes minor paperwork errors and omissions.
Medical facilities of every sort really need a team of auditors—people who can dot every “I” and cross every “T.” These auditors can spot and correct potential problems because they are educated in the insurance company’s thought processes. Our team uses this process to recoup revenue for our clients every single day.
The Claims Resolution solution
A new client of ours in Salt Lake City is currently facing the same situation as the Cochise Medical Center, with one important exception: they won’t be closing their doors. We’re working hard to turn their situation around.
Here’s how our process works. We start by cleaning up patient intake procedures, since this is where so many claims start to go wrong. If any information is missing, incorrect, or unverified insurance companies can and will use these issues against the facility. We create procedures which eliminate these problems.
Next, we move on to coding errors. ABC News reports coding errors of up to 80%, and if their focus is on consumers rather than on facilities this is still an indication that coding errors are pervasive and severe. These errors can and do cause claims denials, so we eliminate them whenever we find them.
We also dig through EoBs to see what the insurance companies are paying, what they’re denying or rejecting, and why. This can give us additional clues about what needs to be corrected before we can start resubmitting claims.
Mistakes are easy to make, which is why we say every practice needs a diligent team devoted to finding and eliminating errors. Eliminating mistakes eliminates insurance company excuses.
It is, of course, always more profitable and easier to resolve matters with the insurance company than it is to attempt to secure payment in full from the patient. Your patients wouldn’t pay their premiums month after month if they had the ability to take care of a $150,000 medical bill themselves. Patients also tend to become infuriated when they hear their insurance plan hasn’t taken care of the bill as anticipated. And why not? They’ve upheld their end of the bargain by showing up with a valid insurance card in hand.
If your facility has been waiting so long to get paid you’re in danger of closing your doors, call the Claims Resolutions team. We can help your practice get the money it’s owed so you can continue serving your patients.