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Persistence pays in obtaining late, unpaid insurance reimbursements

Getting the patient involved from the start can help give practices leverage should a conflict arise.

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PHOENIX — Persistence, along with knowledge of state and federal regulations, can have a profound effect on orthopedic practices’ success in chasing down unpaid or late insurance reimbursements, according to Jerry Bridge, a collections expert.

“The squeaky wheel gets the grease,” Bridge said here at the Bones Society Inc. 37th Annual Conference. “You want the insurance company to know you are not to be messed with.”

Bridge laid out five key steps for getting paid “promptly and fairly” and for short-circuiting the runaround confronting many practices’ collections administrators regarding insurance reimbursements. The five steps include:

1. Getting the patient involved to help receive payments faster. One way: Have them sign a complaint letter at the time of service, which can be mailed once reimbursements go past due. This avoids having to re-contact the patient when getting their cooperation may be more difficult.
2. Use stampers and stickers. “For any claim that leaves your office by paper or any report, you can stamp in bright colors ‘Attention! Unless this claim is paid or denied in ___ days, I will file a written formal complaint to the insurance commissioner.’”
3. Record verification and preauthorization of benefits phone calls just as insurers do. Such records can be useful should disputes later arise.
4. Use aging reports and trial balances to identify the worst offenders.
5. Send appeals letters.

In addition, Bridge recommended knowing key federal rules and clauses for late payments and having a full range of ready-to-go form letters that tap that knowledge. He also recommended approaches for dealing with insurance company representatives.

For example, insurance companies often tell collection administrators that a claim never arrived. Getting a return receipt for claim filings is one way to help solve that problem. Another is having some good scripts for staff to use to challenge company representatives, he said.

“If they say they have never received the claim, ask them, ‘Shall I hold the phone while you research and process this claim, or shall I have to name you and your supervisor personally in my written, formal complaint, signed by your premium-paying subscriber, to the insurance commissioner and the attorney general in this state? What would like me to do?,’” he said.

Bridge is president of Jerry Bridge Practice Management in San Diego.

For more information:

• Bridge J. Get paid now — Collect from insurance companies and patients. #400. Presented at the Bones Society Inc. 37th Annual Conference. May 21-23, 2006. Phoenix.