If a medical practice fails to receive payment from a health plan for services rendered to a plan enrollee, usually it is because the practice believes the patient to be an eligible beneficiary of a health plan when he or she actually is not.
When this happens, practices are forced to act as bill collectors and track down payments from their patients, provided the applicable contract permits such collection.
Certainly, keeping track of coverage eligibility for all of your patients who are enrolled in one type of health care plan or another is difficult. There is no denying the obvious "hassle factor." And, the more plans in which your practice participates, the bigger the problem.
However, in contrast, every time a payor rejects a claim, your practice is not only inconvenienced, but also short-changed. Dealing with rejected health plan claims for payment is costlier than you might imagine. Take a look at your practice’s actual numbers for the past three years; ask the following:
