Medical Practices Struggle to Collect Payments Due to New Payer Tactics

March 15, 2014
P.J. Cloud-Moulds

Insurance companies are being sneaky about keeping your money. Here are some of those secrets they'd rather you not know, and what you can do about it.

Over the past month or so, we've seen so many side effects from insurance companies both opting in to provide insurance through the health insurance exchanges and opting out.  Those that opted in are losing a lot of money right now due to the low number of enrollees.  Those that opted out are also losing a lot of money because they lost several of their clients when they dropped them from enrollment. 

Here's how those side effects are trickling down to medical practices:

1. Insurance companies that typically paid you within 15 days to 20 days are now holding onto that money and making more money in interest on it, leaving your cash flow suffering.  I'm also finding that they you are not paying until you call asking where that money is.

2. Insurance companies are dropping claims stating, “We never received those dates” when the two dates before and the two dates after, all within the same batch, have been paid.  This is resulting in your billing department having to follow up on all claims older than 30 days.

3. Insurance companies are creating narrow networks and patients are having difficulty finding in-network providers.  This means that many of your patients may have to pay out of network rates.  They not only have high deductibles, they also have high premiums.

4. Insurance companies are hiring outsourced auditors to review every single claim they have paid you.  If they find one error, they're coming after that money.  I once had to write a refund check for 4 cents.  Yes, 4 cents.  This can be devastating to your bank account.

Essentially, these changes mean that your practice will be more and more strapped for basic cash flow.  Payroll, expenses, administrative time chasing this money down, are all a drain to your business.   Your businesses accounts receivable should be considered an asset until it starts costing your more to obtain that money than you are paid for that claim. 

Here are some tips you can implement right now to help you get through this new “norm.”

1. Be sure your billing staff is calling on claims older than 30 days to 45 days if you are typically paid sooner.

2. Your billing department should have access to your clearinghouse website and be able to prove that all claims were sent on time..

3. Start keeping a list of alpha-prefixes or some type of identifier that shows it's a newer plan and you are perhaps not in network. When calling and verifying, do not assume you are in network.  Ask the rep: “Are we in network with this plan?” and if you are not, ask for out of network benefits.  I'm also seeing that many specialties are not a plan benefit, so even if you are in network, your specialty may not be covered.  In this case, you will need to turn the patient into a cash paying patient. 

Keep your eye on your accounts receivable and your bank account.  It is imperative that you own this area of your business in this volatile insurance fiasco.