Early Out ProgramDesigned to identify additional insurance billing and to prompt patients to pay.
Health Care Organizations have historically benefited from our Early Out Programs that iare designed to identify additional insurance billing and to prompt patients to pay, thereby eliminating the need for extensive collection activity. Southwest Recovery Services uses letters to notify the patient that their account has been placed with Southwest Recovery Services and of their responsibility for the outstanding balance. Our letter requests that payment in full be made or for the patient or responsible party to contact our office immediately.
The patients contacting our office will speak with a trained Account Agent who will determine the patient’s situation and determine the most appropriate treatment action needed for resolution of the account. We have designed our Early Out Program to be flexible and it can be custom designed to fit your organization’s specific requirements. The benefit to you, our client, is the third party participation in the liquidation of your accounts receivable. Payment notices from an outside partner prompts quicker action from your patients.
Early Out Program Objectives
- We can identify lost opportunities of revenues within days of you clinical services being rendered.
- Our program can identify patients that are awaiting medical assistance eligibility determination as quickly as possible.
- We can work with insurance companies that require pre-authorizations or other documents that your patient is required to provide thus assuring the internal requirements are being met so you get paid.
- Working with patients who have no insurance who are classified as self pay accounts to setup payment plans and make sure they make any and all payments in a timely manner.
- Benchmark the performance against initial conditions of account status.
- Work with client on registration and preauthorization improvement processes based on the identification of weaknesses through quantitative measurements of all collection data.
- Extensive ongoing reporting that keeps all key management up-to-date.
- By implementing our early out program, fewer accounts go to collections which yield measurable returns as early in the collection process as possible.
All of our programs are customized to meet your needs. However, we have listed below a standard package that is currently utilized by several of our clients.
EO CZ190 Process Overview
Here is the typical workflow of the Early Out Debt Recovery Program
- New assignments processed thru an address validation or a standardized NCOA program.
- Three customizable Self-Pay notices are sent to each patient within a 45 day period.
- An intensive telephone follow-up occurs on our predictive dialer platform including an automated voice broadcasting campaign.
- Three-letter notice series starts once insurance is billed specific to the payer type.
- Insurance verification procedures are performed when new insurance information is obtained. This includes initial billing and resubmission of insurance claims as required.
- Follow-up to payers on active insurance accounts.
- Payer issues are identified and reported back to clients.
- Denials and underpayments appealed if appropriate.
- Legal intervention is initiated when contract issues are identified.
- Clients may receive performance reports either weekly, monthly or on request.
- 3rd party eligibility screening is performed.
- Self-pay high-balance accounts have credit inquiries and asset searches performed.
Early Out and HIPAA
It is important to distinguish between collection programs and early out programs as liability issues and HIPAA requirements become a major concern. Compliance is always addressed and adhered to. Our business structure is such that we are able to offer our services as a medical billing agency not as a collection agency. Listed below are the parameters and guidelines as defined by the FDCPA.
Section 803(6)(F)(iii)--"Early Out" Programs: Section 803(6) of the FDCPA sets forth a number of specific exemptions from the law, one of which is collection activity by a party that "concerns a debt which was not in default at the time it was obtained by such person."(25) The exemption was designed to avoid application of the FDCPA to mortgage servicing companies, whose business is accepting and recording payments on current debts.(26) The theory behind the exemption was that the Act should not apply to a business whose focus was the routine processing of remittances (as opposed to the collection of delinquent accounts) simply because such business continued to work an account after the account went into default. The Commission staff has become aware, however, of a number of industry members that acquire all of the accounts of their clients (hospitals or other service providers) at an early stage when the accounts are current (sometimes called an "early out" program) and then claim exemption from the FDCPA because each account constitutes a "debt that was not in default when it was obtained" from the creditor. In fact, collection of delinquent debts is the major focus of these businesses. Apart from the fact that they acquire accounts prior to default, these businesses function in all respects like typical debt collectors. Nevertheless, they can argue that they are exempt from the FDCPA. The Commission believes that Section 803(6)(F)(iii) was designed to exempt only businesses whose collection of delinquent debts is secondary to their function of servicing current accounts. However, the existing formulation of the exemption, which focuses on the status of the individual debts at the time they are obtained by the third party, allows collectors that obtain current debts that routinely go into default to escape the coverage of the FDCPA.
Why Early Out
Early Out Debt Recovery is Flexible
Early-Out Programs are very flexible. Management has the ability to make changes quickly to free-up key employees to concentrate on more important areas of your business, and increase cash flow, while simultaneously reducing overhead.
Timely and efficient collection action is the key to keeping receivables in check and avoiding the unnecessary aging of accounts. Too often, receivables are left sitting, waiting to be called and followed up on, because the in-house staff is over burdened, or inexperienced. This is the worst situation possible since receivables become more uncollectible in proportion to their age.
Early Out Debt Settlement is Faster
The Early-Out Dent Settlement Program will “penetrate” a list of accounts much faster and more efficiently than in-house staff.
Higher penetration means going through a list of accounts from beginning to end, several times, to actually reach more debtors, and request payment. This is done through the use of predictive telephone dialing equipment that eliminated no answers and busy signals allowing collectors to spend up to 400% more time talking to debtors. Add to this the ability to work evenings and weekends to ensure a higher contact rate. Timely and efficient list penetration is of utmost importance to good collection efforts.
Increased ‘”inbound” telephone contact directed to your office, due to the high number of messages that will be left with debtors should also be considered. You must have sufficient staff to handle the increased inbound calls, or we can handle it for you at a small additional cost. It is always more desirable to have a professional answering these calls to ensure maximum results.
Good follow-up is essential after a debtor has been contacted. It is not enough to have us send notices and make phone calls since good credit policies are dependent on good follow-up procedures. This comes into play when payment arrangements are made and follow-up with the debtor is necessary because the debtor did not make their payment as promised. We will separate, keep track of, and follow-up on these accounts for you if desired.
The costs of an Early-Out Program are dependent on the services required to accommodate your special needs.
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