Recovering the Usual and Customary Rate- What the Healthcare Provider Should Know
The settlements reached earlier this year between New York Attorney General Andrew Cuomo and a group comprised of the largest health insurers in the United States have prompted a series of lawsuits throughout the country against major health plans such as Wellpoint, AETNA, and Cigna. A summary of this litigation can be found on this website. Essentially, the lawsuits claim that companies utilizing the Ingenix database have inappropriately manipulated the level of reimbursement paid to providers for out of network medical care to the detriment of members and providers.
When a provider treats a patient needing emergency medical services who subscribes to a health plan that is not contracted with the provider, there is no set rate at which the provider should be paid. Many statutes provide that in this situation the provider is to be reimbursed at the "usual and customary rate." In Florida, for example, according to Florida Statutes section 641.513(5), the plan must reimburse the provider at the lesser of the provider's billed charges, the agreed upon rate, or the usual and customary rate. But few, if any, define what "usual and customary" means or how it should be calculated, and as a result, providers and plans often disagree as to the appropriate level of reimbursement.
The most recent lawsuits should demonstrate to providers of all sizes that they do have recourse when they are being underpaid by one or more Managed Care Organizations. The Healthcare Reimbursement and Latest News sections of our website have more information on how consulting an attorney can be of benefit. for more comments and infomation check our site at www.greenprofitrecovery.com
Sunday, September 26, 2010
Saturday, September 18, 2010
Collecting Payments Due - Small Business Collections
Once an account is past due, companies that haven't been paid can employ various tactics. Fred Steingold, a business lawyer in Ann Arbor, Mich., and the author of The Legal Guide for Starting and Running a Small Business (Nolo Press, $24.95), says companies that are owed should create a series of increasingly urgent reminders insisting on payment. Past-due notices should be sent promptly and should ask clearly for payment, he says.
Les Clark, president of The Credit Recovery Co. Inc., a Woburn, Mass., collection agency, says companies should take a somewhat different approach. He says one friendly reminder letter after the original bill is enough, and then it's time for the next step.
"You don't send out 15 more bills," he says. "You may send out a second bill and say, 'Gee, we haven't heard from you,' and then you specify a payment date that's maybe 10 days to two weeks later. If you don't get something then, you re on the phone. But most firms, because it's easier to do, send out bill after bill after bill."
Bob Ragland, owner of a, ServiceMaster franchise in Columbia, Mo., files a lien against the property of clients who fall 90 days in arrears. That way Ragland- whose business does home cleaning and post-disaster repair-is almost sure to be paid eventually, and usually just the threat of a lien is enough to make people pay up.
Such tactics are rarely necessary, he says, because he bills quickly-within 48 hours of providing a service-and follows up with both a letter and a phone call if he's not paid within 30 days.
The Final Steps
If your firm is owed payment on a number of past-due bills, consider turning them over to a collection agency. But remember that the agency will keep from one-third to one-half of the amount collected. Some agencies also charge their clients for small-claims-court costs if the collection process goes that far, check us out today at www.greenprofitrecovery.com
Les Clark, president of The Credit Recovery Co. Inc., a Woburn, Mass., collection agency, says companies should take a somewhat different approach. He says one friendly reminder letter after the original bill is enough, and then it's time for the next step.
"You don't send out 15 more bills," he says. "You may send out a second bill and say, 'Gee, we haven't heard from you,' and then you specify a payment date that's maybe 10 days to two weeks later. If you don't get something then, you re on the phone. But most firms, because it's easier to do, send out bill after bill after bill."
Bob Ragland, owner of a, ServiceMaster franchise in Columbia, Mo., files a lien against the property of clients who fall 90 days in arrears. That way Ragland- whose business does home cleaning and post-disaster repair-is almost sure to be paid eventually, and usually just the threat of a lien is enough to make people pay up.
Such tactics are rarely necessary, he says, because he bills quickly-within 48 hours of providing a service-and follows up with both a letter and a phone call if he's not paid within 30 days.
The Final Steps
If your firm is owed payment on a number of past-due bills, consider turning them over to a collection agency. But remember that the agency will keep from one-third to one-half of the amount collected. Some agencies also charge their clients for small-claims-court costs if the collection process goes that far, check us out today at www.greenprofitrecovery.com
Friday, September 17, 2010
Tuesday, September 14, 2010
Transworld Systems Celebrating 10 Years as a Medical Group Management Association Adminiserve Partner
Transworld Systems, the industry leader in profit recovery, is celebrating 10 Years as a Medical Group Management Association (MGMA) AdminiServe Partner this year. MGMA is the premier membership association for professional administrators and leaders of medical group practices and AdminiServe is the branded name for the Association's preferred supplier network.
Through the MGMA AdminiServe® partnership, Transworld Systems has recovered more than $290 million for MGMA members while providing a very significant return on investment.
"This milestone is a testament to the success of the partnership, which ultimately benefits MGMA members. We have been working with the MGMA for over 10 years now, and we couldn't be happier with the results. This partnership is clearly a win-win.," said Ken Eissing, Senior Vice President and General Manager for Transworld Systems.
"The numbers speak for themselves - recovery of over $290 million with a 50 percent recovery rate and an ROI of almost 3,400 percent with a collection cost of 2.9 percent, "said Steve Hellebush, MGMA's Vice President of Business Development. "Transworld and the MGMA AdminiServe program continue to provide significant value to MGMA members and their organizations. All of our AdminiServe partners are focused on helping our members succeed, while delivering first-rate service. We proudly celebrate 10 years with Transworld Systems."
Transworld Systems has been an MGMA AdminiServe Partner since 1998. The Company's GreenFlagSM Profit Recovery service handles accounts receivable from early past due accounts through hard-to-collect delinquent accounts. MGMA selected Transworld Systems as their preferred profit recovery supplier due to their low flat-fee pricing, national presence, industry leading recovery rates and their diplomatic, third-party approach.
"Since July 2001, Transworld Systems has collected over $2,442,000 for our office in delinquent insurance claims with their insurance recovery program. The collection cost was a mere 1.2%. We also use Transworld Systems on our private pay accounts at 2% collection cost." - Ruby Dust - Administrator Surgery, Inc in Tulsa, Oklahoma
About Transworld Systems Inc.
Transworld Systems Inc. ®, a wholly owned subsidiary of NCO Group, Inc.®, is an industry leader in profit recovery with headquarters in Santa Rosa, CA, and more than 100 offices throughout the United States and Puerto Rico. Transworld and its service brand GreenFlagSM Profit Recovery are redefining the collection industry by providing businesses with better tools for recovering bad debt and past due accounts. With a success rate more than triple the industry average, Transworld has collected $2.4 billion over the past 5 years for more than 60,000 clients. For more information, call 1.866.629.9092 or visit www.greenprofitrecovery.com.
About MGMA
MGMA is the premier membership association for professional administrators and leaders of medical group practices. Since 1926, MGMA has delivered networking, professional education and resources, and political advocacy for medical practice management. Today, MGMA's 21,500 members lead 13,500 organizations nationwide in which some 270,000 physicians provide more than 40 percent of the health care services delivered in the United States.
MGMA's mission is to continually improve the performance of medical group practice professionals and the organizations they represent. MGMA promotes the group practice model as the optimal framework for health care delivery, assisting group practices in providing efficient, safe, patient-focused and affordable care. MGMA is headquartered in Englewood, Colo., and maintains a government affairs office in Washington, D.C. Please visit www.mgma.com.
Through the MGMA AdminiServe® partnership, Transworld Systems has recovered more than $290 million for MGMA members while providing a very significant return on investment.
"This milestone is a testament to the success of the partnership, which ultimately benefits MGMA members. We have been working with the MGMA for over 10 years now, and we couldn't be happier with the results. This partnership is clearly a win-win.," said Ken Eissing, Senior Vice President and General Manager for Transworld Systems.
"The numbers speak for themselves - recovery of over $290 million with a 50 percent recovery rate and an ROI of almost 3,400 percent with a collection cost of 2.9 percent, "said Steve Hellebush, MGMA's Vice President of Business Development. "Transworld and the MGMA AdminiServe program continue to provide significant value to MGMA members and their organizations. All of our AdminiServe partners are focused on helping our members succeed, while delivering first-rate service. We proudly celebrate 10 years with Transworld Systems."
Transworld Systems has been an MGMA AdminiServe Partner since 1998. The Company's GreenFlagSM Profit Recovery service handles accounts receivable from early past due accounts through hard-to-collect delinquent accounts. MGMA selected Transworld Systems as their preferred profit recovery supplier due to their low flat-fee pricing, national presence, industry leading recovery rates and their diplomatic, third-party approach.
"Since July 2001, Transworld Systems has collected over $2,442,000 for our office in delinquent insurance claims with their insurance recovery program. The collection cost was a mere 1.2%. We also use Transworld Systems on our private pay accounts at 2% collection cost." - Ruby Dust - Administrator Surgery, Inc in Tulsa, Oklahoma
About Transworld Systems Inc.
Transworld Systems Inc. ®, a wholly owned subsidiary of NCO Group, Inc.®, is an industry leader in profit recovery with headquarters in Santa Rosa, CA, and more than 100 offices throughout the United States and Puerto Rico. Transworld and its service brand GreenFlagSM Profit Recovery are redefining the collection industry by providing businesses with better tools for recovering bad debt and past due accounts. With a success rate more than triple the industry average, Transworld has collected $2.4 billion over the past 5 years for more than 60,000 clients. For more information, call 1.866.629.9092 or visit www.greenprofitrecovery.com.
About MGMA
MGMA is the premier membership association for professional administrators and leaders of medical group practices. Since 1926, MGMA has delivered networking, professional education and resources, and political advocacy for medical practice management. Today, MGMA's 21,500 members lead 13,500 organizations nationwide in which some 270,000 physicians provide more than 40 percent of the health care services delivered in the United States.
MGMA's mission is to continually improve the performance of medical group practice professionals and the organizations they represent. MGMA promotes the group practice model as the optimal framework for health care delivery, assisting group practices in providing efficient, safe, patient-focused and affordable care. MGMA is headquartered in Englewood, Colo., and maintains a government affairs office in Washington, D.C. Please visit www.mgma.com.
Saturday, September 11, 2010
Transworld Systems' GreenFlag Accelerator Offers Businesses and Healthcare Providers a Cash Flow Stimulus Program:
Transworld Systems recently introduced GreenFlag Accelerator, a new service that stimulates cash flow by systematically following up on early stage past due accounts. GreenFlag Accelerator provides businesses and healthcare providers with the ability to send reminder letters and make initial reminder calls in their own name before the account is sent to collections. This results in invoices being paid faster and valuable customer and patient relationships being retained. This innovative new service brings the benefits of a sophisticated outsourcing program, typically only available to very large organizations, to businesses and healthcare providers of all sizes.
GreenFlag Accelerator adds to the suite of cash flow and accounts receivable management services Transworld Systems' offers to its clients. Clients can use GreenFlag Accelerator for accounts as early as one day past due and if needed, then take advantage of the GreenFlag Profit Recovery service for accounts at 60-120 days past due and Transworld Systems Collections for older, hard to collect accounts. Through its established and ever expanding suite of services, Transworld Systems offers businesses and healthcare providers of all sizes multiple solutions for their cash flow and accounts receivable management needs.
"Our clients asked us to provide a solution that allows them to systematically follow up on their very early stage past due accounts in a way that stimulates cash flow while retaining their valuable customer and patient relationships," said Ken Eissing, Senior Vice President & General Manager, Transworld Systems. "By bringing the benefits of sophisticated outsourcing programs to businesses and healthcare providers of all sizes, GreenFlag Accelerator enables any size organization to enjoy a systematic and sophisticated early stage delinquency management solution."
"We couldn't be happier with the initial response to GreenFlag Accelerator," says Eissing. "Our clients are telling us GreenFlag Accelerator is what they were looking for. We're excited to be able to provide another new valuable service to our clients."
For more information on Transworld Systems' GreenFlag Accelerator service, visit the website at http://www.transworldsystems.com/greenflag-accelerator.html.
About Transworld Systems Inc.
Transworld Systems Inc.®, a wholly owned subsidiary of NCO Group, Inc.®, is an industry leader in cash flow management and profit recovery with headquarters in Santa Rosa, CA, and more than 100 offices throughout the United States and Puerto Rico. Transworld and its service brands GreenFlag Accelerator and GreenFlag Profit Recovery have been serving the Accounts Receivable needs of small to medium sized businesses with better tools for increasing cash flow, accelerating payments, recovering bad debt and recovering past due accounts. Transworld has recovered $2.4 billion over the past 5 years for more than 60,000 clients. For more information, call 1.866.629.9092 or visit www.greenprofitrecovery.com
GreenFlag Accelerator adds to the suite of cash flow and accounts receivable management services Transworld Systems' offers to its clients. Clients can use GreenFlag Accelerator for accounts as early as one day past due and if needed, then take advantage of the GreenFlag Profit Recovery service for accounts at 60-120 days past due and Transworld Systems Collections for older, hard to collect accounts. Through its established and ever expanding suite of services, Transworld Systems offers businesses and healthcare providers of all sizes multiple solutions for their cash flow and accounts receivable management needs.
"Our clients asked us to provide a solution that allows them to systematically follow up on their very early stage past due accounts in a way that stimulates cash flow while retaining their valuable customer and patient relationships," said Ken Eissing, Senior Vice President & General Manager, Transworld Systems. "By bringing the benefits of sophisticated outsourcing programs to businesses and healthcare providers of all sizes, GreenFlag Accelerator enables any size organization to enjoy a systematic and sophisticated early stage delinquency management solution."
"We couldn't be happier with the initial response to GreenFlag Accelerator," says Eissing. "Our clients are telling us GreenFlag Accelerator is what they were looking for. We're excited to be able to provide another new valuable service to our clients."
For more information on Transworld Systems' GreenFlag Accelerator service, visit the website at http://www.transworldsystems.com/greenflag-accelerator.html.
About Transworld Systems Inc.
Transworld Systems Inc.®, a wholly owned subsidiary of NCO Group, Inc.®, is an industry leader in cash flow management and profit recovery with headquarters in Santa Rosa, CA, and more than 100 offices throughout the United States and Puerto Rico. Transworld and its service brands GreenFlag Accelerator and GreenFlag Profit Recovery have been serving the Accounts Receivable needs of small to medium sized businesses with better tools for increasing cash flow, accelerating payments, recovering bad debt and recovering past due accounts. Transworld has recovered $2.4 billion over the past 5 years for more than 60,000 clients. For more information, call 1.866.629.9092 or visit www.greenprofitrecovery.com
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