ACSI provides a full range of collection services on all medical debts beginning with our comprehensive portfolio services as described here. Within those comprehensive portfolio services, we also integrate the expertise necessary to meet the varying and unique requirements that pertain specifically to collecting healthcare accounts receivable, including other program payment eligibility and the sensitive nature of collecting debts from individuals who have or are dealing with health issues.
Once contact has been initiated with a patient, conversations can begin to determine how patients’ debts can be resolved. This dialogue is conducted with a professional and respectful posture and in a manner that elicits cooperation and focuses on debt resolution options. ACSI’s Recovery Agents are trained to collect on the debt types to which they are assigned. As such, they have the background to knowledgeably converse with patients, help them identify potential payment resources, and present them with the option(s) that best meet their current situation. ACSI’s debt resolution services include:
Healthcare accounts placed with ACSI for collection are self-pay accounts for which the patient is identified as the responsible party for paying the balance due. However, once contact is established with a patient, it may be discovered that the patient has other health insurance coverage or other payment support for which they qualify. ACSI’s Recovery Agents are knowledgeable in these various program areas, including Medicare and Medicaid, commercial and employer insurance, and charity care.
During contact with all patients, ACSI’s Recovery Agents obtain financial status information and explore funding sources with them. If Recovery Agents discover that patients are enrolled in Medicare/Medicaid or have insurance coverage that should have been applied to their bills, then Recovery Agents will ask patients to provide all documentation supporting their claims. Upon receipt of this documentation, ACSI scans and attaches it to the patient’s account history file on the collection system and forward those accounts to our healthcare clients for review. If Recovery Agents discover patients that are eligible to have a certain portion of their bills resolved via charity care based on their financial situation, then they forward those accounts along with any supporting financial information obtained from patients to our healthcare clients for review, as well.
Our staff of highly trained Recovery Agents takes a unique, non-adversarial approach to securing payment from patients responsible for financing their own medical treatment. ACSI’s experience indicates that successful recovery is based on our ability to develop and understand the patient’s financial situation. We forbid the confrontational and harassing policies utilized by many agencies. Instead, ACSI works with the patient to reach repayment terms acceptable to all parties to satisfy outstanding co-insurance, co-pays, deductibles, package deals, and other individual payments.
Managed Healthcare Reimbursement
ACSI pursues payment from Managed Care Organizations, Medicare, and Medicaid. In addition to bill submission and resubmission, ACSI appeals underpayments, denials based upon lack of prior authorization, lack of medical necessity, preexisting medical conditions, and partially approved hospitalizations (carve-outs), among other things. The Managed Care division’s Recovery Agents have special knowledge and understanding of the managed healthcare industry, possess the ability and skill to interpret managed care contracts and understand billing and reimbursement policies, and can navigate successfully through the grievance and appeal process.
ACSI frequently encounters and provides appropriate solutions for the following:
- Denials for untimely filing
- Denials for lack of authorization
- Denials based on lack of medical necessity
- Contractual carve-outs
- Underpayments under non-participating provider statutes
- Emergency Medical Treatment and Active Labor Act (EMTALA) disputes
- Employee Retirement Income Security Act (ERISA) benefits denials
- Coordination of available benefits
Third- Party Billing Follow Up
ACSI routinely secures payment on Personal Injury Protection (PIP) benefits, provider liens against patient recoveries for third party negligence, and workers’ compensation claims regardless of whether these claims are controverted, denied, or otherwise disputed. ACSI’ staff diligently and efficiently audits provider admission data to identify any account for which a third party may be financially responsible. Upon making this determination, ACSI will identify the responsible parties, file and record the appropriate documents, and maintain communication on a regular basis to ensure the provider’s charges are protected. Finally, in the event that the provider’s demand for payment is not honored, ACSI’s healthcare reimbursement attorneys can recommend to the provider a legal course of action designed to hold the responsible third party liable for the charges.