“Denial Codes To Help Collect more Revenue and Increase Patient Satisfaction” April 5 th 2016.

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Presentation transcript:

“Denial Codes To Help Collect more Revenue and Increase Patient Satisfaction” April 5 th 2016

COLLECTION AGENCY Ridiculously nice…

Kenlyn T. Gretz President and CEO of…

This is not legal advice. You should contact your company attorney for legal advice.

Would you like your collection agency to collect more money?

Would you like increased patient satisfaction?

Would you like to increase the productivity of your business office co-workers?

Yes, Yes, Yes!

Insurance Claim 1.Patient receives services. 2.Provider bills insurance. 3.Insurance denies because they need patient information. 4.Insurance company mails EBO to patient. 5.Patient opens the EBO letter, calls the insurance company to resolve. 6.Insurance company pays the provider!

Insurance Claim 1.Patient receives services. 2.Provider bills insurance. 3.Insurance denies because they need patient information. 4.Insurance company mails EBO to patient and patient doesn’t read it or open it. 5.Provider calls patient and never connects. 6.Account drops to self pay, statements are ignored and the account eventually drops to bad debt.

To be clear: Not all consumers listed for collection are listed because they don’t have the money, some just don’t get healthcare.

The Call! »“I was calling you regarding the $678 owed to ABC Provider. Were you planning on paying the balance this Friday or would next Friday be better for you?” »Truth or Stall for more time? »“My insurance company should have paid more?”

The Collector Response “Oh, Okay. Good bye.”

We don’t want to give false information, if we have no information.

The Patient Responses »“I am not paying a dime until I talk to my insurance company.” »“The hospital said they would bill the insurance for me, this is their responsibility to get the insurance to pay.” »“I’ve tried to call my insurance company, I can never get through.” »“I don’t have my insurance information with me.”

The Collector Response »“I am so happy I reached you, I reviewed the account and you are right. Your insurance company denied the bill. They want you to call them and tell them how you were injured. As long as they know that no other party is responsible for the bill, they will pay it. Would you have your insurance card with you? We can do a three way call with the insurance company and I can walk you through how to handle this or I can transfer you to our insurance department?”

Increased Patient Satisfaction One call resolution!

We spend less time checking on things with your team, which equals more productivity for your team.

Call Backs To Follow Up »We estimate that 35% of the consumers we are supposed to call back after gathering data, either never answer the phone again or the phone number is disconnected.

Claims Insurance »On average, we have about 4,000 referrals per month to our insurance department. »On average, 1,400 of those are filed with a new insurance claim. »At times, we have to reach out to your staff for information to file a claim or to follow-up.

24 Americollect teammates certified through AAHAM as Certified Revenue Cycle Specialists!

Example Denials »Expenses incurred after coverage terminated. »Our records indicate that this dependent is not an eligible dependent, as defined. »Charges do not meet qualifications for emergent/urgent care. »This is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.

Guarantor DOB and SSN »New York Attorney General Eric Schneiderman settlement with the three major credit bureaus has impact on medical debt. »Your new account placement data files need to include either the guarantor SSN or DOB to get placed on a credit file effective »Contact and ask the » announces-groundbreaking-consumer-protection- settlement-three-nationalhttp:// announces-groundbreaking-consumer-protection- settlement-three-national

Upcoming Webinars »501r (4) Financial Assistance Policy – Learn the requirements to stay compliant. Thursday, April 7, :00 PM - 1:45 PM CST »501r (6) Extraordinary Collection Actions– Learn the requirements to stay compliant. Thursday, April 14, :00 PM - 1:45 PM CST »Call Miner: Ridiculously Nice Collects More – learn how speech analytics shows that being nice collects more money. Tuesday, June 21st, :00 PM - 1:45 PM CST To register for webinars please visit

Thank You. SIX time winner of Inc Magazine’s Fastest Growing Private Company – ! And we just found out we‘ve been honored for a 7 th year! SEVEN time winner of Inside ARM Best Places to Work in Collections!