May 4, 2016
Billing and collection – what’s the big deal???
Don’t you just send a bill out, and then the insurance company pays ? Like in 2 weeks, right ? Sorry to bust your bubble, but it just doesn’t work like that. Not if you’re infusing IG, and not if your patient’s coverage is through United Healthcare. Not if you are out-of-network. We begin with dropping a paper claim with supporting documents (infusion log, progress notes, etc.) to UHC. With the documentation, we are trying to make it simple for United. Just pay. No reason to delay. Unless that is their strategy. All that is needed has been included with the initial bill. Unfortunately, that works about 20% of the time. UHC knows that if it sends the claim to Optum, additional weeks will go by before they have to pay. We check the status of each claim on-line to see if it is processing, or if it’s been forwarded to Optum. Here’s one of our frustrations: the documentation we send with the original claim is not forwarded to Optum. We have to wait until a request is generated by Optum asking for add’l docs. Holy cow ! What in the heck ?! Actually we use more colorful language than that in house. If we don’t say it, we think it, for sure. Once we verify on-line that Optum is requesting additional documentation (i.e., what we’ve already sent previously to UHC), we respond even before we receive their letter. That saves between 7-10 days. Oh by the way, nothing can be faxed to Optum. Everything has to be snail-mailed. How’s your blood pressure at this point? Once Optum verifies that we have adequate documentation for our claim, they send approval to UHC. I’d like to tell you they process payment at that point, but that doesn’t always happen. On numerous occasions, “somehow” the authorization to pay is lost in transmittal. So WE have to secure the approval reference # from Optum and then call UHC in order to put the claim back for final payment. Bottom line ? In the end, we do prevail. That’s the good news. We are smart and tenacious. We are thorough. We are motivated. We are mission-driven. Plus we work in tandem with an extraordinary group of docs, nurses, and administrative staff who are likewise. We are part of something special, and we see that most clearly in the lives of our patients and their families. What’s the big deal? THEY ARE !!
Chief Business Officer, CHS
Our amazing billing team of Amy, Stacy, & Vonnie always manage to stay on top of the UHC craziness! (and they still have their hair!)
We had such a great time!!
Patient Care, Beyond Healthcare
We are so blessed to have the best staff in the business!!