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Best Practices for Insurance & Medicare Payer reimbursement system - How to get paid?!

I am working with a small company that is considering entering a line of business that involves insurance and/or Medicare/Medicaid reimbursement.  We know that there are many pitfalls of the reimbursement systems and I'm wondering if anyone has detailed information (good or bad) on their own experience with:

- slow cash flow due to reimbursement cycle (what are you averaging?)

- Broker type repricing houses, for 10%~30% fee they'll do collections on your behalf (Do they really pay in 30 days?  Is the appeals process a bear for charges kicked out of insurance system?)

- Preferred Payer programs, giving up at least 10% retail price.  How fast (Slow??) do they actually pay?

- ***Medicare / Medicaid - deep discounts because Medicare "just won't pay" -- I've heard a rumor that accepting Medicare reimbursement with deep discounts preempts you from being able to use supplemental or other insurance methods?  Has anyone experienced this?  Also, does the deep discounting affect your pricing for non-Medicare transactions??  (*** This one greatly concerns me.)

Any information is greatly appreciated!

Best,  Andria



Ken Mason
Title: Controller
Company: Pascua Yaqui Tribe
LinkedIn Profile
(Controller, Pascua Yaqui Tribe) |

Hi Andria,

I can help with comments about home health if that is the field your company is entering but will leave it to other experts otherwise. Each line of business has its own perils and pitfalls and you need very targeted advice.

Regarding Medicare: plan for broadband access to their electronic systems, hire a biller with strong experience and expertise, plan for surprises (glitches) and stay on top of your chart audits.

Andria Devoe
Title: Corporate Controller
Company: Courtagen Life Sciences, Inc. (FKA Avana..
(Corporate Controller, Courtagen Life Sciences, Inc. (FKA Avanatra Bio)) |

Thanks Ken, can you elaborate on what you mean by Chart Audits?

Ken Mason
Title: Controller
Company: Pascua Yaqui Tribe
LinkedIn Profile
(Controller, Pascua Yaqui Tribe) |

Hi Andrea,

Each episode for each home health client will require that a clinical chart be created in conformity with a set of standards. A chart audit to ensure its completeness and accuracy is required before you render a final bill to Medicare. Billing without a chart audit is a roll of the dice in favor of short-term cash flow, as Medicare or Joint Commission can come in anytime and audit your charts. Nasty outcomes can ensue if you are significantly out of compliance.


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