MedCloud RCM Competency : Collection & Follow-up
Insurance companies are notoriously inconsistent with their claim adjudication practices. At Medcloud, we mitigate those inconsistencies through our Collections Team holding the Insurance Companies accountable through our thorough Follow Up Procedures. We specialize in being persistent and tenacious when dealing with Insurance Companies in all facets which is highlighted no more than in our Post Claim Adjudication practices.
Given the claim by claim complexities presented as challenges by each Carrier, the Post Adjudication process is an area Medcloud capitalizes to increase reimbursement. In many cases, additional documentation or other requests from Insurance Carriers go unmanaged leaving obtainable reimbursement on the table.
Why choose us
Highlights of our Collection & follow-up
- Inquiring on delayed payments
- Follow up on adjudicated claims ensuring they have been processed correctly
- Recovery of pending payments
Beginning with accurate billing and coding our team works closely with the insurance company to ensure that the all potential obstacles are addressed and the claims are reimbursed timely.
The Medcloud team provides the required support and information to insurance company to ensure that the claim reimbursement is promptly processed. Our follow up ensures that the collection period is concise.
We follow-up and work towards recovering overdue payments from insurance carriers to reimburse the patients treatment contusing different strategies to most effectively recover the payments.
The Medical Collector has the primary responsibility of reviewing all insurance claim determinations and take all further steps necessary to satisfy payment including but not limited to corrections, insurance appeals, and/or negotiate the claim.
Duties include, but are not limited to:
- Negotiates settlement offers from Third Party Negotiation companies to expedite payment and circumvent the appeal process
- Identifies and processes anti-assignment payments per protocol
- Deals directly with the third-party administrator, insurance carriers, and workers comp. adjusters to successfully perform redeterminations.
- Uses internal software for filing appeals (both ERISA, and non-ERISA) to insurance carriers and employer groups stating a sound case as to why there should be additional reimbursement on a medical service performed
- Performs other charged responsibilities include dealings with the insurance companies to verify eligibility and benefits, assignment/anti-assignment, disputing patient coverage and following up on appeals, negotiations and redeterminations
- Review tasks daily to assure all account that require additional follow up get completed
- Reviews insurance correspondence and identifies, reports and responds to overpayment requests and recoupments
- Prepares accounts for external review, as needed.