The Complexity Of Medical Bills And Collections:
Medical Bills and Collections undergo a complex process. Knowing how these processes move, the timing of important phases, and options/alternatives when things don’t go as planned can help medical providers and their billing teams save time, make money, and avoid stress.
This guide explains when medical bills come due, how long a medical bill must remain unpaid before collections, and how Medical Billing Services, Revenue Cycle Management Services, and Practice Management Consulting can support healthcare providers and patients in effective payment management.
At CBS Medical Billing And Consulting, we promise to help medical providers achieve clean claims, getting more money reimbursed for their services from insurance providers in a timely fashion. To learn more, keep reading or feel free to contact us!
Life Cycle Of A Medical Bill
Step 1: Submitting A Claim To Insurance
A claim is generated by the healthcare provider once a patient has received medical services. It contains requisite patient information such as:
- Patient layers (Name, Date of Birth, Insurance ID, and so forth)
- Procedure codes (CPT codes that safeguard the services rendered)
- Diagnosis codes (ICD-10 codes spell out actual reasons which made it essential to perform a certain service)
- Provider details (NPI number, Tax ID, and so forth)
Except for the claim being accurate, legitimate, complete, and properly coded according to all regulations, it means clean in the health insurance language and can avoid putting the claim denied or causing delays in payment.
What Is A Clean Claim?
A clean claim is one that:
- Contains all valid and complete information
- Is coded properly according to generally accepted industry standards
- Is erroneously submitted on time
- Meets the payers’ specific guidelines
The clean claim reduces the distressing administration pains to the providers and thus fastens reimbursement from the insurance company.
Step 2: Processing The Claim
On receiving the claim, the insurance company subjects it to checks and guarantees that it checks the following:
- Initial Review: Insurance companies check to see if the patient is eligible for coverage.
- Medical Necessity Checking: The insurance policy will check if the treatment is compatible with the diagnosis.
- Billing Code Review: It determines which CPT and ICD-10 codes were used on the claim.
- Duplicate Claim Checking: The claim checks the insurer’s database to verify if this particular claim had not already been submitted.
At this time, errors could emerge, and there might be several reasons for rejection or denial. Wrong patient details, missing codes, or mismatches with coverage might lead to complications with the claim. Then, the medical providers would have to correct those errors and resubmit the claim. Unfortunately, this leads to major delays in reimbursement, causing problems for the practices revenue cycle.
Avoiding denials in the first place is the best way to keep money flowing. This is exactly why our promise of clean claims is so crucial for business owners and practitioners operating a medical practice. We help ensure that your revenues are coming in smoothly so you don’t get stuck without any capitol for essential operations.
Step 3: Reimbursement and Patient Responsibility
Once the claim is processed, the insurance company determines how much of the bill they will cover and how much the patient must pay out-of-pocket.
The insurer will provide an Explanation of Benefits (EOB) to the provider and patient, showing:
- Approved payment amount
- Deductibles, copays, and coinsurance
- Denial reasons (if it applies)
Then the provider bills the patient the remaining balance. Patients who don’t understand their bills might take longer to pay or default altogether, increasing unpaid accounts.
CBS helps lessen this burden by providing patient-friendly billing solutions that communicate payments and options clearly.
Step 4: How Clean Claims Avoid Collections
No one wants to be sent to Collections, nor does a medical provider want to send anyone there. When an unpaid bill is sent to a collections agency, it damages credit, harms patient-provider relationships, and increases the financial burden on healthcare facilities. Medical debt is a huge issue in the modern economy, and at CBS, we see clean claims as a way to lessen the issue.
How Clean Claims Reduce Collections
- More timely reimbursement: Clean claims processed efficiently mean faster reimbursement for the provider and less out-of-pocket balance for the patient.
- Reduced denial and appeals: Errors in submitting claims require reprocessing, which delays payments and frustrates both the provider and patient.
- Better patient communication: Clear billing practices help explain to a patient their financial responsibility upfront, ensuring understanding and enabling smooth payments.
With CBS claims being filed cleanly the first time around, there will be little or no need for further resubmissions, ensuring no revenue lost and fewer awkward scenarios going to collections.
CBS Ensures Clean Claims, Limits Collections, And Helps Medical Practices Grow
CBS is involved in Medical Billing, Revenue Cycle Management, and Practice Consulting, providing healthcare providers with assistance to maximize revenue and minimize claim rejections.
Key Services Offered by CBS
- Medical claim scrubbing: Ensuring all claims are prequalified to meet the specific requirements of payers.
- Insurance verification: Checking with the insurance entity regarding eligibility status before performing services.
- Denial Management: Addressing clinical and clerical aspects to resubmit rejected claims promptly, avoiding additional delays.
- Patient Billing Solutions: Clear, straightforward bills that reduce confusion and encourage quick payments.
CBS claims handling allows the provider to focus on patient care, rather than chasing unpaid bills.
Understanding Medical Bills And Collection Timelines
In this section, we want to speak to patients of medical services. While we all go to doctors and receive medical services, the behind the scenes billing process is not well understood at all.
A Baseline For The Medical Billing Process
Initial Billing
Following completion of services, the healthcare facility makes a claim to the insurance of that patient. The insurance company processes said claim and determines how much it will reimburse, but any remainder is left to the patient’s out of pocket expense.
Patient Statement
After the insurance adjustments, the patient receives a statement referring to what they owe. This bill generally has a due date of 30-90 days.
Reminders and Notices
After the due date passes, the healthcare provider notifies the patient by mail, email, or phone.
Final Notice
If reminders get unanswered, the provider sends one last notice, informing that the account may go to collections.
When Does A Medical Bill Go to Collections?
Normally, your bill is sent to collections 90 to 180 days after becoming overdue. However, according to policy, it varies from provider to provider as well as on other factors like whether or not the customer reaches out to communicate about their difficulties in paying.
Factors That Influence When Medical Bills Go To Collections
Provider Policies
Some healthcare providers may send unpaid bills for collection after 90 days while others may take only six months.
Patient Communication
The provider may delay putting an unpaid bill into collections if a patient contacts them about a payment plan.
Insurance Disputes
If an insurance provider is in ongoing disputes, collections could be postponed until the matter is resolved.
How To Prevent Medical Bills From Going to Collections
– Pay Bills On Time
While this advice may be simple, it’s effective. Pay the bills on time to avoid miscellaneous charges and collections.
– Set Up A Payment Plan
Many providers will set up installment plans to assist the patient in paying medical-related bills. By breaking the bill up into pieces, it’s easier to progress towards its completion. The age old saying asks, “how do you eat an elephant..?”
– Check For Billing Errors
Make sure there aren’t discrepancies in the charges before making payment. It may be difficult to review the medical bill, but it’s time well invested.
– Check Coverage With Insurance Provider
Know what is covered by your insurance and resolve any claim denials as quickly as possible. Your insurance agent should be your representative, if you feel they aren’t doing their part, don’t be afraid to call your agent and ask questions.
– Communicate With Medical Providers
If you won’t be able to pay on time, talk to your provider and get options. Most people go into the field of medical practice because they want to help, help them help you.
Consequences Of Medical Bills Going to Collections
When medical bills go to collections, a patient should be aware of the potential various consequences:
– Damaging Credit Score
A bill would hit the credit bureau at above the threshold of $500, assuming that it stays unpaid for more than a year, and be expected to thereby produce a reduction in the credit score.
– Litigation With Lenders
The collections agency could bring a lawsuit against a patient so that they could recover a debt for garnishment of wages, for example.
– Further Stress On The Economy
Fighting with the collections industry may prove debilitatingly, especially when you have bigger issues, like being sick or struggling with an ongoing medical condition
– Denial Of Medical Care
Patients burdened with unpaid balances could easily be denied all but emergency treatment.
How to Protect Yourself From Unpaid Medical Bills, Medical Debt, And Collections
If you are struggling with your medical debt, here are the steps that you can follow to prevent your bills from getting into collections:
– Know Your Rights
Learn rights for patients and billing procedures to avoid unnecessary copayments or charge expenses.
– Request An Itemized Bill
Carefully look at the bill and check if all charges are correctly included.
– Negotiate Cost
If you cannot afford to pay a certain fee, ask about discounts or other options.
– Stay in Communication with Providers
Keep them informed about your payment choices that they may advise.
– Monitoring Your Credit Reports
Watch out for discrepancies with any of the medical debt.
If you’re a patient struggling to understand your medical bills, don’t be afraid to ask your insurance agent and medical providers questions. With greater knowledge comes less fear. Get informed and be proactive so you can avoid the negative consequences of medical debt.
At the end of the day CBS Medical Billing & Consulting serves medical providers. However, as partners with those medical practices, our joint goal is to help people receive better, more affordable patient care. We hope some of these insights may serve those of you looking for a greater understanding of the Medical Billing Process and Medical Collections.
Now, we’ll continue to speak to our partners in Medical Practice.
Benefits of Outsourcing Medical Billing Services
Medical Billing and Consulting Services provide dynamic, yet specialized expertise needed to improve the overall billing procedures of healthcare providers while ensuring they maximize revenues and prioritize patient care. You can help your patients avoid medical debt, collections, and all kinds of financial pain by improving your billing practices. More and more, medical practices choose to pursue a partner who can help them with their medical billing via Outsourced Medical Billing Services.
Here’s a short list of benefits:
Cost Reduction
This eliminates the burden of maintaining in-house billing, thus lessening overhead costs.
Expert Guidance
Ensure that there will be professionals who handle the billing process. While your administrative team is no doubt capable, it’s nice to have specialists around who can provide guidance and help navigate complex or out-of-the-ordinary scenarios.
Focus On Patient Care
Provides an opportunity for providers to concentrate on patient care rather than administrative tasks.
Did you know recent studies show that the average doctor/practitioner spends only 11 minutes treating a patient, and 28 minutes formatting the necessary paperwork?
This absurdity is unaligned with the essence of quality medical care. So, we seek to relieve medical practice owners and practitioners of administrative hang ups and hurdles so they can serve their patients with full attention and without worry.
Improved Compliance
Fewer billing errors and adherence to healthcare acts helps everyone move through the medical billing maze with greater ease and less stress. Avoid audits, do it right the first time!
So, You Know More About Medical Bills And Collections, Now What?
The better your medical billing system, the fewer problems with payments. It’s that simple.
Outsourced Medical Billing Services offered by Medical Billing Companies, like CBS Medical Billing and Consulting, offer healthcare providers an opportunity to take a major administrative weight off their shoulders. We partner with medical providers so they can focus on patient care instead of medical billing.
