October 2002

How to Get the ‘King’ to Pay
Insurance Collection Procedures You Can Start Using Today
By Peter G. Fernandez, DC

Insurance companies “reign” over the money you’ve earned in providing services to their clients; they decide what you will be paid, and they can easily manipulate “when” you will be paid. There are specific procedures that you can incorporate into your practice that can help improve how timely your patient insurance claims are paid.

One of the most vital of those procedures is the insurance telephone collection procedure. The following information explains the two most common insurance telephone collection scenarios and the corresponding telephone procedure that is the most productive and effective in getting the “king” to pay.

When first implementing this insurance telephone collection procedure, start with your larger unpaid insurance claims first, then collect your smaller balances. After that, your telephone collection procedures should be initiated by your insurance collection CA on each patient’s claim that is not paid within 30 days of billing.

The following collection procedure requires the CA to set up and use a numerical file system for follow-up activity. This numerical file system is simply an accordion-type paper file with slots numbered 1 through 31 - one for each day of the month. The accordion file should be large enough to hold insurance paperwork and the CA’s collection conversation notes. If a large enough accordion file cannot be found, you and your staff can make your own by numbering 31 file folders and putting them in their own easy-to-maneuver file box or case.

Both of the telephone insurance collection scenarios we will discuss begin like this:
The CA first looks up the patient’s insurance claim number as found on any correspondence received from the insurance company in regards to that particular case, or the patient’s policy number as found on the patient’s insurance card or insurance policy.

The CA calls the insurance adjuster and states in a very pleasant tone:
“Hi, this is Sally from Dr. Fernandez’ office. I am calling you in reference to your insured, Mrs. Mary Jones, your claim #MJ2384 (or, your policy #123456). Normally your insurance company pays us very quickly. However, on Mrs. Jones’ claim, we have not received any payment.”
Then the CA asks: “Is there a problem with the claim, or are there any questions that I can answer for you?”
At this point, the CA will be faced with one of the two following scenarios:
• Insurance collection scenario #1:
In the first scenario, the insurance adjuster locates the claim form and has some questions. The CA answers those questions and then asks the adjuster if he/she has any more questions.

When all the adjuster’s questions have been answered, the CA asks:
“Is there anything else I can do to help you with the claim?”
The CA continues to ask this question and provide the requested information until the insurance adjuster tells her there is nothing else needed.
The CA will then end the telephone conversation with:
“When will you be sending the check to pay this claim?”
Typically, insurance claims are paid on the 1st and 15th of each month, but the insurance adjuster should be able to tell you when your particular claim is scheduled for payment.

The CA should write up a detailed account of the conversation, including date, name of adjuster, what problems occurred with the claim (if any), questions asked and their answers, and month and day of expected payment.

The CA initials this written account, highlights the month and day that the payment is expected to be made, and places it in the numerical file slot that corresponds with the date that is seven calendar days (this allows for mail transit time) after the promised payment date. For example, if the insurance adjuster told the CA the payment should be sent on May 15, the insurance CA would highlight the payment expected date (May 15) and then file the conversation documentation in the numerical slot #22.

Sample of conversation documentation:
“3/18/02 - Spoke to ABC Insurance adjuster, Mark Smith (555-432-2145, ext. 586). He asked (note the actual questions) and I told him (note the answers). Mr. Smith said that should satisfy everything they need and the check for Betty Jones’ bill of $234.05 should be paid on 4/01/02. VMC (CA’s initials)

If the insurance check is not received by the day that your follow-up reminder pops up in your numerical file system (this would be seven days after the promised date), the CA will call the insurance adjuster and follow the same question, answer, and numerical filing of documentation procedures as detailed previously. Again, it is extremely important that the CA maintain a pleasant tone of voice and a, “What can I do to help you?” attitude when he/she speaks with the insurance adjuster.

• Insurance collection scenario #2:
In the second scenario, the insurance adjuster locates the claim form and tells the CA that additional information is needed in order to process the claim (i.e., didn’t receive the doctor’s bill, need SOAP notes, etc.) The CA writes down what the adjuster needs and repeats it back to him/her so there is no misunderstanding. The CA tells the adjuster the information will be sent immediately and thanks the adjuster for his/her help.

The CA immediately sends the information to the adjuster:
By mail: The CA verifies the address to which the adjuster would like the information mailed and sends it certified, return receipt. In addition to the CA’s written detailed account of the conversation, including date, name of adjuster, and what was discussed, the CA also places a note of what was mailed, including the sender’s copy of the certified mail receipt, in the numerical file slot that corresponds with the seventh day from the day that the information was mailed.

By Fax: If the insurance adjuster has requested or approved that information be faxed to him/her, the CA would immediately do so.

In addition to the CA’s written detailed account of the conversation, including date, name of adjuster and what was discussed, the CA also places a copy of the fax and fax receipt in the tickler file number that corresponds with the seventh day from the day that the information was faxed.

By E-mail (a Warning!): Under no circumstances is patient information to be e-mailed. This is too risky and could violate patient privacy. When a follow-up notice appears on the CA’s numerical file for that day, he/she telephones the insurance adjuster to verify that he/she has received the requested information.

If the insurance adjuster has not received the information seven days after it was sent, the CA reconfirms the mailing address or fax number and immediately resends the information. The CA would follow the same send, documentation and numerical file procedure described earlier.

If the insurance adjuster has received the information, the CA follows the outlined steps to document and follow-up until the claim is paid.

Dr. Fernandez has more than 20 years of experience as a practice management consultant. He has written hundreds of articles and 17 books on practice-building. He is a 1961 Logan College graduate and past president of the Florida Chiropractic Association. Dr. Fernandez is based in Seminole, Fla., and can be reached at 800-882-4476; drpete@drfernandez.com; or visit his website at www.drfernandez.com