decisionhealth Newsletters, Coder Pink Sheets - 2008 Issue 1 (January)
Accelerate payments by ‘assuming’ non-coverage
Subscribe or sign in to view the full article.
Article Overview
This article explains a practical claims-management strategy for physician practices facing slow or unresponsive private payers. It covers the general reasoning behind the approach, the importance of checking payer contracts and state law, and the use of written notice to both the payer and the member. The piece is relevant to billing staff, practice administrators, and revenue cycle professionals looking for nonclinical ways to address delayed payment issues.
Why This Topic Matters
Delayed payer response can create cash-flow problems and administrative burden for medical practices. Understanding the broad framework described here can help billing teams evaluate whether a similar approach is permissible under their contracts and applicable law.
Article Sections
-
Tactic for delayed private payer claims
Introduces a strategy for addressing unprocessed or unanswered claims from private insurers and describes the general situation that prompted its use.
-
Precautions before using the approach
Summarizes the need to review contractual terms and applicable state law before taking any action related to patient billing or payer notices.
-
Written notice to payer and member
Describes the importance of documenting the practice’s position in writing and sending notice to both the payer and the affected member.
-
Expected payer and patient reactions
Covers the possible responses from payers, patients, and employers once the issue is shifted away from the provider office.
What You Will Learn
- How some practices respond to delayed or ignored private payer claims
- Why contract review and state-law review are important before billing members
- Why written notice to both payer and member is emphasized
- What kinds of operational outcomes practices may be trying to achieve with this approach
Who Should Read This
- Physician practices
- Billing staff
- Practice administrators
- Revenue cycle professionals
- Medical office managers
Subscribe or sign in to view the full article.
Quick, Current, Complete - www.findacode.com