Benefits to the clients: Outsourcing small balance accounts will allow the most accounts to be worked at the least cost to the client. Outsourcing will increase production allowing client staff to focus more on large account balance, increasing overall cash flow and monies collected sooner. This will help reduce the amount of AR outstanding , also help reduce AR days and in some cases reduce the bad debt reserves.
LMS's procedures for small balance accounts are as follows: All new account placements will be worked with in 5 days of receipt of placement. Have a UB or HCFA on all accounts. If the primary carrier has paid, an EOB from primary carrier. Prepare a status request letter and attach the bill and EOB (if applicable) and mail to the proper carrier. Flag account to be reworked within 30 days. 30 days: If the carrier does not respond to the written request for status, check all previous account notes. Call the carrier for status. If claim has not been received we verify mailing address. If the address is the same one used we ask them to check again for the claim. If they still can not locate the claim, verify the patient was covered at the time of service. If the patient was covered at time of service ask if you can fax them the claim. If they allow us to fax we will get the fax number and the name of the person to fax it to. We advise we are faxing the claim now, we immediately fax the claim. Flag the claim for 3 days and follow up to see if claim was received. If they will not allow us to fax the claim we mail the claim to address verified by the representative . Flag the account for 30 days. At the end of 30 days will call the carrier and get status of the claim. If the claim is still not on file we will ask to speak with the supervisor. Ask them to allow us to fax the claim and we will have them hold until the claim is received. When they verify the claim has been received ask them if they have all necessary info to process the claim.
If the carrier denies the claim are procedures are as follows: The patient was not covered at DOS we will check other accounts for additional information if no information close and return to bill pt.
The services were not authorized close and return for pt to be billed.
COB information is needed we will check other accounts and see if they paid other accounts around that DOS, call the patient. If unable to contact patient we will mail the patient a letter. Flag account for 30 days.
Accident details are needed from the patient in order to process the claim, we will check accounts and see if they paid other claims for this accident, call the patient. If unable to contact patient, we will mail them an accident detail request letter. Flag for 30 days.
Past time filing limit:Send an appeal. If appeal is denied close and return.
Can not id patient we will call the patient for insurance information. If unable to contact the patient we will mail a letter requesting insurance information.If information is not received with in 30 days we will close and return to bill the patient.
Add pay denied we will verify the patients responsibility. If we are still underpaid we will file an appeal. Flag for 30 days. After 30 days send status request letter for the appeal.
Need Medicare EOB ask if the insured was actively employed at DOS if so we will then follow our Medicare procedure.
Investigating Pre-existing condition ask for the effective date of the policy and we will follow our pre-existing condition procedure.
The balance of the small balance accounts are determined by the client. 1,000.00 and under 700.00 and under 500.00 and under 250.00 and under
Age of accounts are also determined by client. 0-30 days 60 days 90 days 120 days 150-365 days 365+ days
Fees are based upon what program fits the clients needs ranging from 8%-33%. For example : Account placed at 90 days with a balance of 750.00 and under would be 10% fee.
When the account has been determined uncollectible and there is patient resposible we can close and return the account to the hospital, we can send the cliam to our Hospital Billing Service, or we can send the claim to be placed with a collection agency of your choice if no preference we will place the accounts with Accounts Services, Inc.. This will procedure will allow the account to be finalized without the involvment of the client.
Our Small Balance Account Program can be customized for each individual clients needs. LMS will take any small balance account with balance due from insurance carrier. LMS will take the accounts at an early age and complete the process of billing, re-billing and or expediting insurance payments. LMS's Claim Specialist will work all denials in a timely manner to get problem corrected and claim processed for payment as promptly as possible.