Statement
Five statement Cycles
1.Current - intial statement
2.31-60 Days (1-2 months) - Second statement
3.61-90 Days ( 2-3 months) - Third statement
4.91-120 Days (4-5) Months) Fourth statement
5.Over 120 Days (5-6 Months)
Step one - Separate all statements by billing cycles.
No insurance Statements - PLEASE MAKE THIS A PRIORTY
If there are any statements that have a billed amount for office visits, EKGs, echos, etc. (example: $420, $27.00, $75.00, $1750.00) No insurance, please do your best to separate and pull those statements. It's important that we submit the claims as promptly as we can to the insurance companies. The faster we acquire the necessary information, the faster the claim can be processed.
Insurance companies have established specific guidelines regarding the timeframe for claim submission. It is crucial to note that if the specified timeframe of, let's say, 90 days is not adhered to, the claim may be denied due to being submitted late. This unfortunate circumstance could potentially result in a loss of revenue. Therefore, it is of utmost importance that we ensure the timely submission of all claims.
Please refer to the Timely Filing table for claim submission.
Call the number provided on the account. Please let them know the reason for the call.
Example: Greetings, I am __, representing Capital Pediatrics Cardiology. I am reaching out to request essential details pertaining to a claim we are currently processing with your insurance provider. Regrettably, we do not possess the required information in our records (after diligently cross-referencing their personal details, such as date of birth, address, and full name). This procedure ensures our strict compliance with HIPAA regulations.
Request the insurance and also inform them about the claim that is being billed.
1. Name of the insurance company (Blue Cross, Blue Shield, United Healthcare, etc.)
2. Insurer Name (Person responsible for the insurance)
3. Insurer Date of birth. (Parent/person responsible for the insurance)
**Please not the account that you made an attempt to obtain the insurance information. **
Current - Cycle 1
This would be the initial statement that is being presented. It is crucial that we verify our accuracy by ensuring that the Explanation of Benefits (EOB) aligns with the statements.
During any office visit, our office policy and procedures dictate that we collect copays, deductibles, and co-insurance. It is important to ensure that any out-of-pocket expenses are properly applied to the account. We have noticed that there have been instances where payments were not correctly applied, so it is crucial to cross-reference the superbill in the patient's folder for the receipt. This process helps us avoid billing the guarantor incorrectly and prevents any miscommunication.
It is imperative that we diligently monitor the statements for any pending charges. This ensures that we promptly address the pending charges and furnish the insurance company with any necessary information. It also allows us to verify that there are no errors on our part during the billing of the claim.
Kindly follow up on any pending charges and ensure that an account note is made. This ensures that the account is not being worked on twice.
Once the current statement has been revised and is accurate, this ensures that we will not have to re-visit and verify the accuracy of the statement. Please be on the look out for secondary insurance as well, in some cases
31-60 Days -Cycle two
Given the revised accuracy of the statement from its initial claim, Stage two of the billing cycle becomes straightforward. It involves carefully reviewing each statement to determine if the corresponding account has been paid. If the account balance is zero, it indicates that the statement can be discarded. It is crucial to emphasize the importance of diligently following up on any pending charges. Also make sure that the address on the registration we have on file is correct. Address placed on the gurantor account is the mailing address.
Please note that the address on the patient's account is separate from the billing address. Kindly ensure accuracy when verifying this information.
61-91 days - Cycle Three
A past due amount stamp needs to be added to the statement. At this point, we kindly reach out to the guarantor to inquire about any updates in their address. We offer them the choice of a payment plan or the convenience of making a payment over the phone. If the guarantor mentions that they haven't received a statement, we propose sending the state via email. If an email is sent, there is no need to worry about mailing out the statement again.
Please ensure that the email is encrypted to comply with HIPAA guidelines
If the guarantor requests a payment plan, we promptly offer the possibility of auto-pay. Our aim is to facilitate their payment process for utmost convenience.
If they do not answer, kindly leave a voicemail regarding the outstanding balance.
Please create an account note if you have left a voicemail. This ensures that we have made an effort to contact them.
Please refer to different types of script >> Click HERE<<
Example: We are calling with an important message for (Guarantor name). Our records show you have a balance due on your account. If you have just paid your account, we thank you and ask that you please disregard this call. If you would like to make a payment please give a call at 916-750-2328.
91-120 Days - Cycle 4
Given the revised accuracy of the statement from its initial claim, Stage four of the billing cycle becomes straightforward. It involves carefully reviewing each statement to determine if the corresponding account has been paid. If the account balance is zero, it indicates that the statement can be discarded. It is crucial to emphasize the importance of diligently following up on any pending charges. Also make sure that the address on the registration we have on file is correct. Address placed on the gurantor account is the mailing address.
120 Days Over -Cycle 5 Final Statement
Last statement that will be sent out. There needs to be five in total of statements that are saved in the
The final statement letter must be attached to this claim.
In Epic, please navigate to Guarantor activities > Click on Letters >
Click on the magnifying icon and select SCC FINAL COLLECTION LETTER.
Attach the fifth statement to this letter.
This correspondence serves as official documentation in our billing cycle that a final statement was indeed sent before transferring the account to collections.
Any outstanding account balance that remains unpaid after six statements will be referred to a collections agency. We kindly request that you visit the TSI website for further assistance.
>>Click Here<< TSI Instructions
Last update on 02/15/2024 DP