As many of our healthcare provider clients see their businesses slowing in the face of the
Coronavirus pandemic, we are increasingly hearing a common question:

“What can we do to bring in revenue to keep our doors open?!”

Here’s one easy answer:

Collect your old A/R!

If you are like many providers, you probably have a significant amount of unpaid, under-paid, or unsettled claims with commercial payers.  When times are good, it’s easy to write-off those claims, or to decide that aggressively pursuing those claims would be “biting the hand that feeds you.”

But in the times we’re facing right now . . . collect!!

Here are four things you can do TODAY to maximize reimbursement for services already rendered:

  1. Crunch your claims data. Before you can pursue your old A/R, you must know where it comes from.  Which payers are denying claims for which services, and for which reasons? Are some CPT or revenue codes being denied more than others? Are claims being denied for coding issues? Medical necessity? Coverage issues? And when claims are paid, is the amount consistent with your historical track record?  (And, by the way, in most instances you should be looking at the “allowed amount,” not simply the amount paid, to account for patient deductibles, co-pays, etc.)

    → The more you know about the nature of your A/R, the better positioned you and your attorney will be to effectively and efficiently collect what you’re owed.

  2. Get your paperwork in order. Any attempt to collect old A/R will depend on the existence, quality, and consistency of your own records. Do you have all your payor agreements, including any addenda, supplements, and updates?  Don’t forget about single-case agreements or re-pricing agreements!  For out-of-network claims, it can get complicated. Ideally, for each patient/claim, your records will include at least: verification of benefits notes and/or authorization, admission agreement, assignment of benefits, the claim, EOB/remittance advice, appeal records, and of course a complete and well-organized medical record.

    → The better organized your records, the easier time you and your attorney will have pursuing payment.

  3. Get those Appeals out. All too often when we send demand letters on behalf of providers, the payer responds by denying that the provider submitted a timely appeal to challenge the denial or underpayment. As you crunch your claims data and get your paperwork in order, make sure you or your billing company are submitting written appeals for any and all denied or underpaid claims.

    → Don’t reduce your potential recovery by failing to timely appeal.

  1. Clean up any compliance problems. Experience tells us that the initial response from  commercial payers to aggressive demands for payment on outstanding A/R is to seek out any “pain points” or weaknesses on the provider side that can be exploited.  Among the most frequent targets:  Where the patient is financially responsible for a portion of your charge, can you show a “commercially reasonable” effort to pursue payment from the patient? And if you offer financial hardship discounts, can you establish a rigorous policy, practice, and procedure for evaluating hardship?

    → Getting ahead of issues like these will serve you and your attorney well as you seek to collect on old A/R.

No one knows when we’ll all be back to business as usual. In the meantime, there’s no better way to goose your cashflow than by collecting on old A/R. Get started today!

Nelson Hardiman regularly advises healthcare providers in pursuing commercial insurance reimbursement.  While we try to resolve disputes without litigation, when necessary we aggressively advocate for healthcare providers in arbitration and in State and Federal Courts.

For more information about this client alert, please contact:

Zachary Rothenberg
[email protected]

John A. Mills
[email protected]