Communication with our Intake Coordinator

• Work closely with our Intake Coordinator to relay insurance coverage details promptly.
• Provide clear and concise information to support new client scheduling.
• Address any discrepancies or issues related to insurance coverage proactively.

Client Outreach for Updated Insurance Details

• Proactively reach out to clients when their insurance is set to expire.
• Gather updated insurance information and verify coverage details.
• Clearly communicate payment responsibilities to clients.

Outstanding Client Balances Management

• Run daily reports of outstanding balances.
• Address discrepancies in billing and adjust client account settings accordingly.
• Collect co-pays for providers who failed to collect them at the time of the appointment.
• Maintain a list of clients exempt from immediate collection due to special circumstances.
• Communicate with clients regarding outstanding balances and facilitate payment resolution.
  • Contact clients when credit cards are declined/missing to achieve resolution.
  • Respond to providers letting you know that credit cards are declining.
• Reinforce the policy that the next appointment cannot occur with an outstanding balance.
• Communicate clearly that payments are due at the time of the appointment.

Client Account Settings Management

• In the case of client fees changing after claims are returned, communicate to clients and adjust account settings accordingly (when co-pays or deductibles change).
• Ensure the client account settings are properly configured for either insurance appointments or private pay appointments
• Ensure that all transactions or refunds are allocated properly (any transactions that are unallocated must be allocated promptly)
  
  

Billing Adjustments for Late-Cancellations and No-Show Appointments

• Communicate with providers on a case-by-case basis to determine fees for late-cancellations and no-shows.
  • For Medicaid clients, ensure late-cancellations and no-shows are dropped properly.
  • For commercial/private pay clients, follow individual provider preferences for fees.
• Set the billable item for Late-Cancellations and No-Show Appointments to self-pay, not on “insurance,” for reporting purposes. Change the CPT code accordingly (we have different codes for each missed appointment scenario, this is important for reporting purposes)

Secondary Insurance Co-Pay Adjustments

• Drop false client balances that result from co-pays from the primary insurance

Client Credits Management

• Identify client credits resulting from insurance/copay changes or met deductibles.
• Adjust account settings to reflect accurate billing for future appointments.
• Evaluate whether client credits should stay on the account for future use or be refunded.
• Avoid holding credits on accounts unless certain they will be used for future appointments.
  • Ensure that providers are properly using client credits

Insurance Credits Management

• Run regular reports to identify insurance credits.
• Identify reasons for insurance credits, such as canceled appointments or billing item misconfigurations.
• Resolve credits by adjusting write-off amounts associated with negative payments accurately.
• Set any false write-off amounts to zero dollars to rectify insurance credit issues.
• Collaborate with billing and administrative teams to resolve complex insurance credit issues.

Insurance Balance Management (Unpaid Insurance Appointments)

• Regularly run reports to identify unpaid insurance appointments and outstanding balances.
• Investigate the reasons behind unpaid claims and address issues promptly.
• Request detailed explanations of denials from the billing team to identify and resolve root causes.
• Determine if unpaid insurance appointments are within the normal pending period or indicate an issue.
• Investigate and address reasons such as expired insurance, COB updates, diagnosis acceptance, etc.
• Document all actions taken.

Insurance Overpayments Management

• Regularly run reports to analyze the breakdown of charges, payments, and write-offs to identify discrepancies.
• Resolve overpayments or duplicate payments by adjusting amounts accurately.
• Ensure that the Insurance Paid + Insurance Write Off aligns with the correct insurance responsibility for the appointment.

Unbilled Appointments Monitoring

• Regularly check the insurance section for unbilled appointments.
• Investigate the reasons behind unbilled appointments and claims.
• Address issues of missing diagnoses, missing notes, missing client demographics, and other reasons that may account for an unbilled appointment.

Incomplete Clinical Notes Reports

• Regularly run reports to identify incomplete clinical notes for appointments.
• Proactively remind providers to complete and sign their clinical notes promptly so that billing operations can run smoothly.
• Communicate the policy that claim submissions will not occur until clinical notes are completed and signed.
• Emphasize the importance of completing notes on the date of each appointment to ensure accuracy and timeliness.
• Highlight the impact on billing and overall client care due to incomplete documentation.

Payment Accuracy

• Monitor collections to ensure accurate recording and prevent instances of mistakenly collected “false cash” vs valid credit card transactions.
• Regularly review transactions to identify instances of double-posted payments.
• Address any discrepancies in collections promptly.
• Review and clean up unallocated client payments and credits.
• Ensure that all refunds are accurately allocated and recorded.
• Communicate with providers and staff to address issues related to collections.

Overall Customer Service

• Assist clients and internal staff with inquiries related to insurance coverage.
• Provide guidance on insurance-related questions and concerns.