made a mistake regarding the patient’s insurance eligibility. The hospital proved that it had acted in good faith by checking eligibility and then delivering services to the patient. In an appeals court, the hospital won its right to keep the money it received from the insurer. Thus, some attorneys recommend the inclusion of case law in an appeal letter. The American Medical Association suggests that practices keep logs of all interactions with payors, including takeback requests and appeals. The logs should include payor names, reasons for the takeback requests, dates of appeal attempts, and outcomes of the appeals. Using these logs, practices can identify trends or problems specific to certain payors. If you verify that the insurer is in fact owed the money, do not delay paying it. If your state allows offsets, you want to do whatever it takes to avoid them, since they will cause additional administrative work regarding future claims. Also, if you determine on your own that an insurer has overpaid you, experts agree you should wait until the payor requests the money – which it likely will – or call the insurer to discuss the discrepancy and ask them to send you a formal repayment request. This is not some underhanded strategy to avoid paying back the money. Waiting for a request as opposed to proactively repaying the money simply ensures that your check will end up in the right hands and will be properly credited to your account. Another way a practice can win against payors’ takebacks is to prevent them from happening in the first place. The activity logs I mentioned earlier will help your billing staff identify any trends that may be causing the payment errors. These trends can then be used as leverage during your next contract negotiation with a payor. For example, establish time limits on takeback requests and have those written into the new contract. Finally, investing in a revenue cycle management (RCM) system that helps ensure clean claims and verifies patient eligibility will improve claims processing and reduce errors. If your client’s practice receives a takeback request, take the time to ensure the request is valid. In doing so, you can potentially save your client money. ■ David Doyle is the chief executive officer at CRT Medical Systems, a top 100 medical billing company serving clients throughout Michigan and the Midwest. FEATURE STORY Billing Update! We are working hard to enhance Billing to ensure that it meets the needs of our membership, but want your input. As you see, each issue has been greatly expanded to include topics that impact the healthcare industry and our businesses. Do you have a suggestion for a future column in Billing? Is there a specific topic that you would like to see covered by industry experts? Would you like to write an article? Are there particular subjects that you would like published in future issues? Do you have any comments about past articles? Please offer suggested topics for Sound Off! as well. We are open to any and all suggestions. Please feel free to send any comments about Billing to billing@hbma.org. Thank you! A Few Ways to Obtain CHBME Credits Attend HBMA conferences Take the quiz in Billing Purchase videos by module from the Executive Summit (located at the website) THE JOURNAL OF THE HEALTHCARE BILLING AND MANAGEMENT ASSOCIATION 19
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