A medical practice will need a compliant collections system

On Behalf of | Nov 29, 2021 | Health Care Law

Like any other business, a medical practice has to make sure that it gets timely and fair payment for the services it provides. After all, despite its being a critical service, providing medical care is not at all cheap.

Likewise, physicians and their support team are entitled to take home a just and competitive salary for their efforts. In short, a medical practice cannot survive without revenue.

Navigating the rules of Medicare, other health insurers can be time-consuming

In most cases, the bulk of medical services will get paid through Medicare, Medicaid or a private health insurer.

There are many situations, however, in which Medicare or one of these other insurers may refuse to pay for all or part of a practice’s services.

In the case of Medicare, a provider may need to go through the steps of appealing an adverse decision about payment. An appeal can be critical to getting paid, as the provider’s patient may not have the financial resources necessary to pay out of pocket.

A successful appeal will involve collecting the proper factual support and making persuasive arguments.

Likewise, private insurers may have their own appeals processes in place with which providers will want to be familiar.

If a provider is having difficulty securing payment from a health insurance company, Texas’s Prompt Pay Act may offer the provider some relief. This law requires health insurance companies to pay valid claims within a certain time frame or face the possibility of interest and other penalties.

Navigating this web of rules and regulations can be very time-consuming for a busy physician in the greater Dallas-Fort Worth area. They may wish to seek out professional assistance with developing a plan for dealing with insurance claim payments.

Providers will also need to be mindful of the law when collecting from patients

There will also be some situations in which a provider will bill the patient directly for its services. Since medical bills are sometimes hard for people to anticipate, it can be difficult to collect payment from a patient, especially when a patient claims financial hardship.

In other cases, a patient may just not make it a priority to pay his or her legitimate medical bills.

These are reasons why a physician’s practice will want to have a legal collections program in place. There are many legal considerations, including federal debt collection laws and bankruptcy laws, which a provider must keep in mind when trying to collect on a patient’s balance.