{"id":2930,"date":"2012-06-04T17:30:11","date_gmt":"2012-06-04T21:30:11","guid":{"rendered":"http:\/\/www.poweryourpractice.com\/?p=2930"},"modified":"2012-06-04T17:30:11","modified_gmt":"2012-06-04T21:30:11","slug":"how-to-handle-problem-payers","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/how-to-handle-problem-payers\/","title":{"rendered":"How to Handle Problem Payers"},"content":{"rendered":"<p>You\u2019re doing all the right things with your claims: scrubbing them before submittal, filing them electronically within days of the service date, reviewing your EOBs, and continually monitoring collections. Your claims operations are a well-oiled machine\u2026 except for <strong>one payer that\u2019s gumming up the works<\/strong>.<\/p>\n<p>If you\u2019re dealing with a problem payer that\u2019s ignoring claims, delaying payments, issuing unnecessary denials or <a href=\"https:\/\/www.carecloud.com\/continuum\/3-phases-of-rcm-use-best-practices-to-improve-performance\/\" target=\"_blank\" rel=\"noopener\">underpaying on contracted rates<\/a>, you need to take action.<\/p>\n<p><!--more--><\/p>\n<p>So stand up for your practice! Arm yourself with the right data and address the situation assertively to keep from letting a payer push you around.<\/p>\n<p><strong>Prove It: Aggregate Data for Support<br \/>\n<\/strong>If you\u2019re concerned about a certain payer after noticing a few closely timed underpayments (or other issues), it\u2019s critical to back your suspicions with hard data. Review backlogs of your reports with an eye for the specific information you need.<\/p>\n<p>\u201cGo back a year or so and create a spreadsheet with pertinent information such as the patient name, the date they were seen, the codes you charged, what the insurance paid, the allowed amount, the date the insurance paid, if the patient had a portion to pay (co-insurance, co-pay, deductible) the contractual adjustment, and if there is a remaining balance,\u201d advises blogger P.J. Cloud-Moulds in <a href=\"http:\/\/www.physicianspractice.com\/\" target=\"_blank\" rel=\"noopener\">Physicians Practice<\/a>. \u201cDo this for at least a dozen patients. This will <strong>create a visual map for you to review<\/strong>.\u201d<\/p>\n<p>From that map, determine if your concerns are justified \u2013 or aren\u2019t.<\/p>\n<p>You may have originally thought that the payer was reimbursing your claims too slowly, but if the data shows that you\u2019re being paid within the typical 90-day window \u2013 even if it\u2019s on day 89 \u2013 you should probably hold off on taking your concerns to the insurance company until there\u2019s more tangible proof.<\/p>\n<p><strong>Discuss It: Consult With Your Team on Your Findings<br \/>\n<\/strong>If the stats affirm your suspicions, save copies of your reports with the appropriate information highlighted and share it internally with all necessary interested parties.<\/p>\n<p>It\u2019s important to bounce your findings off at least one other individual with your practice\u2019s best interests in mind, such as the physician most involved in business dealings, your head biller, or the contact at <a href=\"https:\/\/www.carecloud.com\/continuum\/in-house-vs-outsourced-medical-billing-pros-and-cons\/\" target=\"_blank\" rel=\"noopener\">your medical billing service<\/a> (who, if you\u2019re outsourcing, should be highly involved in this process).<\/p>\n<p>One or more of these individuals may have failed to inform you of <strong>details that explain the payer issues<\/strong> you\u2019ve encountered. Perhaps the payer informed your head biller that technology troubles or upgrades caused some claims to be ignored accidentally, or that staffing issues incited a period of payment delays.<\/p>\n<p>Consulting your colleagues provides an opportunity for explanations to come to light before any allegations of misconduct or poor performance are made. Once your team is briefed, take everyone\u2019s knowledge of the situation into account as you decide on a course of action.<\/p>\n<p><strong>Act on It: Contact the Payer &amp; Reach Resolution<br \/>\n<\/strong>Ideally, your goal should be to resolve the situation, and the best way to do that is to straightforwardly present the troubling claims-data findings as a problem the insurer needs to solve.<\/p>\n<p>Get on the phone with your closest contact or rep at the payer company. Lay out the recurring issue you\u2019re facing in as much detail as possible \u2013 the more stats you can relate to, the more likely you are to reach favorable results.<\/p>\n<p>\u201cI have found that 90 percent of denials, improper\u00a0payment amounts, delayed payment, etc. <strong>can be turned\u00a0over by a simple (or not-so-simple) phone call<\/strong>,\u201d says Cheryl Nash of American Physician Financial Solutions.\u00a0\u201cThe reps at the payer are not as well-trained as we would\u00a0like to think, but <em>we<\/em> are.\u201d<\/p>\n<p>Include particulars related to your contracts with the payer and make sure your concerns are escalated to a business manager who can monitor the situation moving forward.<\/p>\n<p>When dealing with the payer, it\u2019s important to act with your patients\u2019 and practice\u2019s best interests in mind. Avoid making threats of cutting off your acceptance of this insurer\u2019s coverage unless you\u2019re truly certain you\u2019re willing to take your actions to that level.<\/p>\n<p>If the payer insures a large portion of your patient base, it may hurt your business more to sever ties than to continue transacting as usual. <a href=\"https:\/\/www.carecloud.com\/continuum\/3-ways-to-clean-up-ar-to-collect-more-money\/\" target=\"_blank\" rel=\"noopener\">Analyze your collections data thoroughly<\/a> to elucidate the potential consequences of cutting them off before you make any comments of that nature.<\/p>\n<p>Whether or not you\u2019d be willing to no longer do business with your problem payer, it\u2019s important that you <strong>approach them assertively and monitor their performance<\/strong> after voicing your concerns.<\/p>\n<p>Your practice works hard to perform at a high level to ensure that both your patients and your bottom line thrive. In return, you shouldn\u2019t be saddled with a payer who underperforms in their dealings with you.<\/p>\n<p><strong>How have you handled a &#8220;problem payer&#8221; situation at your practice?<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>You\u2019re doing all the right things with your claims: scrubbing them before submittal, filing them electronically within days of the service date, reviewing your EOBs, and continually monitoring collections. Your claims operations are a well-oiled machine\u2026 except for one payer that\u2019s gumming up the works. If you\u2019re dealing with a problem payer that\u2019s ignoring claims, [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":32786,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-2930","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-revenue"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>How to Handle Problem Payers - Continuum - CareCloud<\/title>\n<meta name=\"description\" content=\"If you\u2019re dealing with problem payers who ignore claims, delay payments, issue unnecessary denials or underpay, you need to take action.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/carecloud.com\/continuum\/how-to-handle-problem-payers\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"How to Handle Problem Payers - 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