What could your clinic do with an additional $6000? Or much more?
What if you had an ally in the government who could and would be willing to assist you?
An often forgotten or under-utilized ally is your state’s Department of Insurance. We are HRS have had great success by relying on our allies at the DOI to help us collect from commercial payers when they have failed to pay or deny our claims in a timely manner. We have found that one particular payer has a habit of sending our claims to a “black hole” where they are suspended indefinitely with no letter, notice, or EOB ever being sent to us until that payer receives a letter from the DOI outlining our complaint.
We have had separate issues as well with other payers, but we only file a complaint as a last resort and do not abuse the services of our DOI. In the past 6 months, 60% of the cases in which we filed a complaint with our DOI resulted in payment being released by the payer. So far, the total payout has been about $6000 for one small, non-physician clinic. Imagine the possibilities if more clinics, both small and large utilized these resources that are available to them!
It takes about an hour to file a complaint to our DOI, and that includes gathering documentation to submit with the complaint. I calculated that the net payment per hour of complaints filed (including the ones that did not result in payment) is $850 per hour.
Would your clinic like to be paid $850 an hour? Take the time to visit your Your State’s Department of Insurance and learn how to file a complaint against payers. You just may find, as we have, that those letters from the DOI will get you the attention you deserve and thousands of dollars in claims will be waiting for you in your mailbox!
If you find that your clinic simply does not have the time or resources to incorporate this practice into your revenue cycle management, and your accounts receivables are getting out of control, please feel free to give us a call to see if HRS can help your bottom line. 888-211-1118