CMG

Cambridge Management Group

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         GETTING PAID FOR YOUR SERVICES

         A RECIPE FOR MEDICAL COLLECTIONS

INGREDIENTS:

1. Collectors
2. Phone
3. Paper
4. Pencil
5. Follow Up File (electronic or manual)
6. Medical Software Package  (optional)
7. PC    (optional)
8. Modem   (optional)
9. CPT coding book or software
10. HCFA 1500 claim forms
11. Medicare and other insurance fee profiles
 

PROCESS:

1. When appointment is scheduled for a new patient:
a. Get and verify all insurance benefits
b. Inform the patient of any amount due at check in, i.e., co-pay, deductible, co-insurance, etc.
c. If prior authorization for services is required, obtain before scheduled appointment.

2. At time of check in:
a. Get information form and releases completed and signed.
b. Get copy of insurance cards and driver's license.
c. Collect any co pay due.

3. At time of check out:
a. Schedule follow up appointment.
b. Collect any deductible and/or co-insurance due.
c. Remind patient to obtain any additional authorizations required for follow up visit.

4. Process charges and payments for services rendered.

5. Process claims to proper insurance company for services rendered.

6. We recommend follow up phone calls for:
a. Any unpaid electronic claims older than 21 days.
b. Any unpaid paper claims older than 45 days.
Note: -If number of claims requiring follow up exceed 10 per insurance company (except Medicare) send investigative cover letter with Request for Review or copy of the claims.
-For Medicare claims you must use the Auto Response Unit

7. Place notes in a tickler (follow up) file (manual or electronic) for appropriate follow up:
a. Based on the information given at time of phone call.
b. Ten (10) days from date when investigative cover letter sent.

8. Follow Up -  Follow Up  -  Follow Up until the claims are paid.
 

9. Collect from patient any amounts not covered by insurance company - use the same methodology in number 7 and 8.

                             TIPS

· Always check the patient's account the day before the appointment and note any amounts due to collect at time of check in or check out.

· The best time to collect money from your patient is when they are at your office.   Don't let the opportunity pass you by!

· If the patient does not have money due at check out:

. Have them sign a promissory note.

. Give them a self-addressed envelope to send the payment immediately.

. Place a follow up note in your tickler file when payment is due.

. Call 5 days after date the money was due if the money is not received to request payment.

· F O L L O W  U P  is the key to this recipe.

Cambridge Management Group, Inc.
5820-B West Cypress Street
Tampa, Florida 33607
(800)859-1528

e-mail: info@cmgbilling.com