Deductibles, co-insurance, co-pays, denied claims, paid-to-patient checks from insurance companies, travel expenses; the costs of treatment being passed from insurance carriers to patients seems to go up with each passing day so behavioral health providers must be adept at collecting these funds to remain competitive. As this list grows, it becomes harder and harder to pursue this revenue while at the same time focusing on admitting and treating patients with the highest quality care. This could lead to a reduction in the quality of care being delivered, in addition to compliance issues that could cause insurance companies to halt or even claw-back prior payments, not to mention opening up the business and its ownership to legal liabilities.
Cigna and other health insurance companies are once again ramping up audits on behavioral health providers, so what are they looking for? They are specifically targeting centers for collections on patient responsibility. They are picking a sampling of their patients that have received treatment with the provider and demanding records documenting cash collections for deductibles, co-pays, co-insurance etc. they also want to see proof of legitimate collection efforts with respect to their clients.
So why are they doing this? It’s simple, they’re doing this to put treatment centers out of business. They accomplish this when centers cannot provide documented cash collections and attempts. Insurance companies then claw-back reimbursements that can sometimes be in the 6 or even 7 figure range.They also stop paying out pending and new claims, effectively choking out every center they can. They did this quite effectively around 2015 and they are back at it.
Who in your organization wants to call the loved ones of a patient and ask for money? Who knows how to do it? What’s in it for them except for hearing sad stories and excuses? This is an extremely delicate matter and if not handled properly could cause the patient to terminate their treatment early. The fact of the matter is that most staff at treatment centers don’t even believe that you should ask for the money. That represents the shortfall between insurance reimbursement and the actual amount billed. So treatment centers make an effort, albeit a faint effort, but in the end they leave hundreds of thousands of dollars on the table. Money that in some cases is the difference between loss, breaking even and making a profit.
In most cases that is the sad reality. Treatment ends when the insurance spigot gets turned off. But why is that always the case? Because the treatment facility is not adept at communicating the need for the loved one to pay for more treatment out of pocket. Who makes that call? What do you say that is effective? This is an important function that we serve and no one does it better.
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