WHAT IS AN INSURANCE AR COLLECTION LAW FIRM?

Charles J. Hilton & Associates, P.C

Attorneys at Law

“The Solution to the Health Care Provider and Patient Experience”

By

Lyman Sornberger, Director of Client Development

Charles J. Hilton and Associates, P.C

[email protected]

Office 440 546 0947

Healthcare providers spend numerous hours negotiating with insurances companies in good faith for reasonable reimbursement rates. Hospitals and physician’ health systems continue to promote their care delivery model, industry brand name, and patient experience.  

Did you know that there were over 800 mergers and acquisitions in 2018? That is a 10% growth over 2017 in a playing field of 4500 health system providers organizations. The industry is moving to new reimbursement models and consumerism. Is your organization in front of that 2019/2020 change?

While we all work towards understanding the industry disruption with associations, reimbursement, and costs, are we taking every opportunity to be paid what is owed to us today and tomorrow and supporting our patients? 

I will challenge all levels of the Revenue Cycle and Financial space that WE are not. As an example, denial rates increase and the ability to manage them is decreasing yet the cost associated is increasing.  It’s a byproduct of the process and constant changes and take a few moments to act on these thoughts in this brief communication.

Often before the “ink is dry” disputes arise after the insurance company denies a claim and many times without a clear or legitimate explanation or reason. Unfortunately, the provider and sometimes the patient are caught in the middle. It is estimated that more than 30% of provider claims are denied in error and 65% are never appropriately appealed. A significant portion of the providers appeals are not ultimately reimbursed. These as you would expect are often catastrophic or large surgical balances.

Disputes also can occur if insurance companies fail to pay medical providers the money they’re entitled to from policyholders in states with no-fault insurance and personal injury protection, or PIP. Let’s face it, insurance companies are more profitable when providers and policyholders do not file claims or fail to collect on claims submitted under their policies. Based upon our law firm’s thirty years of experience in handling medical insurance claims, insurance companies may deny compensable claims—regardless of their validity.

Unfortunately, insurance companies often interpret the language in their policies to minimize or deny compensable claims. Providers have a significant self-interest to protect their cash flow and demand reimbursement when based on the payer contract; i.e., the claim should be covered. When an insurance company underpays or denies a claim, they may contend that:

1. The loss is excluded from the patient/providers contractual agreement or policy.
2. The damages are less than what the insured is claiming or falls below the policy deductible.
3. The insurance company’s “independent experts” or “independent adjusters” have determined that no covered loss occurred or is excluded from the policy.

Providers in good faith make efforts to challenge or appeal the “valid” claim but are often unsuccessful. Many do not have the resources or knowledge to legitimately make argument to the large or even small insurance giants. I am a firm believer that providers do not challenge inappropriate denials for a variety of reasons  AND as a result, balances that should have been paid remain unpaid.

As a provider with significant challenges to manage health care; are you comfortable that you have taken every step to hold your third-party relationships accountable? In a world of health care challenges where your brand, consumerism, patient experience, cost, and reimbursement confront you daily; are you collecting from insurances every dollar due?

At Charles J. Hilton and Associates, P.C cjhiltonlaw.com: their numerous attorneys understand that when a provider who is supporting their patient as a consumer and who has paid insurance premiums submits a claim to their insurance company, they expect the company will act in good faith and honor the validity of the claim and appropriately reimburse the services. However, many times the insurance company does not honor the claim. I personally can verify that Charles J. Hilton and Associates, P.C.  has supported multiple health systems and even two huge health systems of 6B annual or more in revenues.

Hilton Law as “The Hospital Revenue Cycle Law Firm” assists and promotes medical providers to ensure that they collect their insurance accounts receivable in a cost effective and patient friendly manner. Hilton Law’s mission is to ensure that providers are paid appropriately by insurance carriers in accordance with their agreements and the firm’s vision is to compliment the challenges of the health care provider.

Be responsible and sign up or pilot the opportunity against any internal or external firm.

In summary, do you have a health care law firm in your portfolio of financial opportunities. Having a master agreement in your back pocket is a leading practice and demonstrates proactive management*.

Take a moment to reach out or share this opportunity with your colleagues. You can trust that sign on is simple, the process is minimal, and the cost is much less than trying to do this on your own or leaving the revenue on the table. What do you have to lose?

Be responsible and contact Attorney Charles J. Hilton at [email protected] or call 800 818 4708

* Please note that this partnership is to work with providers and insurance and not to engage the patient. IMPROVE YOUR PATIENT EXPERIENCE AND CASH FLOW!