Tips for Safeguarding Reimbursement
Simple things you can do to prevent your insurance checks from getting into the wrong hands.
By Heather M. Garcia, CBCS, CMAA, CMB
What do you do if a patient receives an insurance check that belongs to your practice? Whether you are in or out of network, it can happen to you. And while nothing is fail proof, there are steps you can take to ensure your practice is paid for services rendered.
How to Ensure You Receive Insurance Checks
You know what they say about an ounce of prevention. To ensure payment, conduct these preliminary steps prior to rendering services to patients:
1. Check Box 27 on the CMS 1500 when sending in your claims to the insurance companies. This confirms you accept assignment, which means you have an assignment of benefits (AOB) on file for the patient. See Form A (on the next page) for a sample form. Part 2 of this step is to make sure you ask patients to sign an AOB form.
Word to the wise: Always consult your healthcare attorney before utilizing any forms within your practice.
2. Submit paper claims with the AOB attached if you know a payer sends checks to patients, or when submitting a workers’ compensation or personal injury protection claim. Be sure to stamp/write on the top of your CMS 1500 forms, “Assignment of Benefits Attached.” That way, a payer can’t say it didn’t receive the AOB. Send the AOB every time you bill to these payers; even if the payer should have the AOB on file, it may not.
3. Keep patients’ Social Security numbers on file. Patients are not always willing to give out this information, nor can you require it, but a Social Security number will help if you need to collect professional fees directly from the patient.
4. Ask patients to sign a form stating that if the patient receives a check from an insurer for services rendered, the patient will send that check to the office within a specified number of days. This should be a standard form given to all patients. It’s better to have the signed form and never to use it, than not to have it at all. See Form B (on page 41) for a sample form.
What to Do When Patients Receive Checks
Regardless of all the steps you take, there will always be some checks that make it to patients. Make sure you’re ready for this if it happens.
1. Be on top of your accounts receivable (especially if you know a particular insurer sends checks to patients). Patients are less likely to cash your checks if they know you’re on top of them. Give the patient a call as soon as you know they have received a check.
2. After you give the patient a call, immediately send him or her a letter with a pre-addressed, stamped envelope, and attach the forms the patient signed regarding receiving checks, just as a reminder. Know your patients, and use this step at your own discretion.
3. Make a follow-up call log. Physician offices are busy places, often making it difficult to remember every interaction you had with patients throughout the day. And keeping track of what everyone else is doing in the office is darn near impossible. Something as simple as a paper log to record phone calls made to patients about payments can help, however.
Make the log a rule. When you contact a patient for a check, write it down. Use the patient’s name, the amount of the check, how many checks are owed, and the date you contacted the patient. Be sure to have a spot to sign if the patient brings in the checks, and leave room for a comment area.
Keep the log where all staff and doctors can access it. If a patient brings in a check when the billing staff is gone for the day, the front desk can initial it in the log. The doctors should be required to do the same if he or she receives checks from a patient. Review the log every two to three days and make follow-up calls, when necessary. The longer the patient has a check, the less likely you are to recover it, so be diligent with your follow up.
4. Stop treating patients who don’t return checks. Many doctors make the mistake of continuing to treat patients who do not return insurance checks to the office. In some instances, the doctors are unaware of the issue due to poor communication within the office. The problem with continuing to treat these patients is they are being paid to go to the doctor, and your office is losing money at every visit.
Tell your doctor about such situations, but don’t get him or her involved. There is a fine line between the clinical side and the business side of the practice. The doctor should never be on the business side (at least not in the patient’s eyes). Communicate with other office staff so they know the situation — especially the front desk, as they are your gatekeepers.
Give the patient options. For instance, you might say, “Mrs. Jones, when you bring in the checks you received from your insurance company, we can get you scheduled for your next visit. If you feel you cannot wait to schedule with us, we can recommend a few other doctors in the area who you can call to see if they have immediate openings available.” If the patient still doesn’t bring in the checks, you must decide if that is a patient you want at your office.
5. If you are unable to recover the checks, decide whether you want to send the patient to collections. This might end with the practice suing the patient in court if he or she doesn’t make a payment arrangement in the collections phase. This is not a step for all offices. You have to decide how aggressive your office wants to be; however, if you took the steps above, you should have the signed documents that will aid you in recovering your professional fees, attorney fee, and any other fees associated with collections. Be certain the collections company/attorney you hire is knowledgeable, so you’re able to recoup all due fees.
Heather M. Garcia, CBCS, CMAA, CMB, has been in the medical billing and consulting business for over 13 years. She launched Smart Healthcare Solutions, Corp., in 2005, and it has offices nationwide. Garcia has been an expert witness in New York litigation trials and has also participated in the Medical Assistant/Medical Coding and Billing Advisory Board for Lincoln Tech. She is a member of the Upper Saddle River, New Jersey, local chapter.