• Overview
• Multi-Phase Process
• Recovery Services

Multi-Phase Process

HCFMA believes that healthcare receivables collections require a multi-phase process for commercial insurance collections and a detailed tracking system to assure optimal collections from government payors. Most collection agencies employ a basic two-phase approach of mass billing/collections and anything that is not collected is generally sent back to the provider, who then must restart collection efforts through legal avenues. At HCFMA, your contingency fee is based on your claims' status and age when these are assigned. HCFMA's alliance with law firms who are well seasoned in the collection of these receivables eliminates the time and expense involved in that transition.

HCFMA management completes a detailed assessment and strategy for each new client. We assess the Accounts Receivable, look for payor patterns and test our initial impressions. We prepare a report of recommended modifications to the forms and procedures retained on-site that are critical to improved collections.

It is our goal to help the provider become self-sufficient. We achieve this by developing strong internal procedures while HCFMA catches up the backlog. HCFMA provides support in improving the pre-service delivery information system of the provider, as well as the provider's documentation of clinical necessity. Depending on the extent of the recommendations for a provider, further consultation and training may be required at nominal consultation fees.

Many clients, particularly those working on a 150- or 180-day collection time limit, contract with HCFMA for the full Multi-Phase process, while others elect to perform Phase One services themselves and have HCFMA provide the additional Phases.

Multi-Phase Collection System

• Phase One:
  The focus involves: accurate billing, electronically whenever possible; monitoring that the claim(s) and certifications were received and are in process; providing clinical documentation, when required; and correcting and rebilling any errors or omissions. Collection calls are made to a maximum of 90 to 120 days unless the claim is paid sooner, denied or other problems are encountered. Any denial or problems immediately go to Phase Two as do all accounts for which there is no Promise To Pay by day 90 or 120.
• Phase Two:
  A senior collector specializing in the type of payor involved takes over the collection of the claim and obtains the added support necessary to get any issues resolved. Any claim requiring clinical appeals or other administrative/legal assistance is immediately referred to Phase Three.
• Phase Three:
  Top management analyzes the collection effort to date, reviewing profiles of the payor and the provider's relationship. Strategies employed at this level include: a criteria based-appeal; a negotiated settlement based on the documented level of care; complaint to the respective State Insurance Commissioner and/or Attorney General.
• Phase Four:
  With the Provider's written consent, the failure of the first three Phases to collect a claim may require a legal collection process. Other factors relevant to a decision to pursue Phase Four include the assessment of the relationship of the provider and payor as noted above