As a billing service, Stagton Practice Management submits claims electronically to insurance companies and mail statements out to patients to collect their portion. While most claims get paid within a few weeks, a small percentage of claims do not get resolved and can be difficult to conclude. Typically, tracers are filed and even phone calls are made to the insurance companies but, unfortunately, you receive marginal if any response. This small percentage of claims often remain uncollected for months. Most practices are not set up as a collection agency to deal with these unpaid accounts, and providers are usually faced with two difficult choices: They can either write off the unpaid accounts or they can refer them to a hard-core collection agency, in which case the medical practice loses 30 to 50 percent of the value of the claim as the fee. In addition to this high fee, the practice will most likely lose the patient as a client because harsh collection measures usually result in the loss of patient goodwill.
Dealing with insurance companies.
The insurance industry is very highly regulated. Given the current climate in the medical field, it is extremely difficult for almost any practice to enforce these regulations upon the industry. Virtually all states have legislation in place requiring insurance companies to pay or deny claims within 30, 45 or 60 days. Yet, billions of dollars in claims are not paid or are denied even within these legal requirements. Stagton Practice Management has developed a program specifically designed to utilize the states’ insurance laws and regulations to force insurance companies to meet the legal requirements governing them.
There are four types of “insurance resolutions” that our program ultimately helps you get:
Cash -- payment for the claim
Denial from the payer (which allows the provider to bill secondary insurance, re-bill the primary with different coding or information, or convert to self-pay)
Information from the payer that no claim is on file (which allows the provider to resubmit the claim, attaching the correspondence from our collection agency to achieve maximum efficiency)
Suspension of action on the claim for whatever other reason the payer might have.
In summary, what we wish to provide the provider and their staff is an ability to close the books on every insurance claim by utilizing this tool only on those specific and few claims requiring this type of additional effort. We will provide this at a fee which frankly is not possible for your company or your staff to approach, not even considering the impact and effectiveness of our national collection program.
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