Over the last ten years, countless physicians’ offices have been snapped up by hospitals and larger networks. These officers were added in order to simplify the provider process, which is easier when everyone is on the same network. It’s also done in order to add to the hospital’s bottom line. Of course, these mergers go better when the CBO (central billing office) has fewer claims to deal with – specifically, fewer claims that are in the middle or at the end of the state-level appeals process.
Physician Merger Process
Merging individual physicians’ offices into a hospital or larger network isn’t easy. The worst part falls to the CBO (central billing office) who must contact all of the commercial insurance companies and deal with a lot of paperwork. On top of that, all of the patients need to be made aware of the change. If the physician’s office is relocating due to the merger, every patient needs to receive a letter informing of the switch. New phone numbers need to be given out. The old phone numbers and the address (yes, the mail) need to be redirected to the new location. It’s very complicated. And we haven’t even addressed the current physicians’ personal contracts and other documents.
While not all of these things fall under the heading of the CBO (central billing office), the people working there have their work cut out for them.
Role Of The CBO (Central Billing Office) During Mergers
The CBO (central billing office) has a very important job to do during the merger process. They need to make the switch from one billing system to another go very smoothly. This may require coming up with new commercial insurance company contracts in order to have the terms match those of the rest of the network. If those payment amounts and codes remain different, this information needs to be noted, or else the current claims will be submitted incorrectly. There’s quite a bit of detail involved for the people in the CBO (central billing office).
On top of that, the CBO (central billing office) also has to try to clear up all of those unpaid and underpaid claims. Why? Because those leftover claims are a hindrance on the new provider network. Look at it this way – a new network means a new CBO (central billing office.) The one that previously sent in those commercial health insurance claims for that physician’s office has essentially been swallowed up by the one in the new network. The commercial health insurance contracts for the new network might be quite different than the old one. Now, when an unpaid claim is sent back to the CBO (central billing office), the employees need to examine it to determine whether it fell under the terms of the new contract or the old one. If it’s under the old one, they’ll need to look up those amounts and codes to ensure that it’s correct before appealing it. This just adds to the paperwork. It creates headaches and makes the process more complicated. It would be much easier if those claims were taken care of before the merger is complete.
You Only Receive Three State-Level Appeals
Every CBO (central billing office) has only three state-level appeals to go through on those unpaid and underpaid claims. After all of them have been rejected, many hospitals and physicians’ offices simply give up. Since the merger process is so complicated, this is a very bad thing. That uncollected money is needed to help the new network stay afloat. Sure, one or two of them may be no big deal in comparison to the amount that gets paid, but every penny counts. When you consider that some of these big hospital and office networks end up going bankrupt because they have too many debts and not enough positive cash flow, it’s easy to see where the problem lies – with those unpaid and underpaid claims.
There’s a good solution to this issue, although a standard CBO (central billing office) is unable to tackle it. This solution involves the Federal ERISA process. Filing an appeal on the federal level will force the commercial insurance companies to pay up. The only issue that many physicians’ network CEOs aren’t really aware that it exists. Many of the CBO (central billing office) employees aren’t aware of it either since this isn’t taught to them. You’ll need to find an expert, like ERISA Recovery, in order to handle the process.
What You Can Do To Solve This Problem
Whether you’re a hospital CEO or the person in charge of a large provider network, you’ve probably heard the term Federal ERISA process before. Just in case (after all, we know that you’re busy and things tend to get forgotten), let’s go over it again. ERISA is short of the Employee Retirement Income Security Act. Despite its name, ERISA covers commercial health insurance claims as well. It’s a federal law that allows hospitals to collect on those commercial health insurance company unpaid and underpaid claims. Even though the company may try to avoid paying them, they are contractually obligated to pay those amounts.
The main issue is that many provider networks and hospitals never go through the ERISA process. Their CBO (central billing office) personnel don’t have the time, nor do they understand how to begin the process. As a result, the commercial insurance companies essentially get away with their practices. Yes, it’s true that most medical billing and coding courses don’t cover how to get those unpaid and underpaid commercial health insurance claims paid based on this federal act. To take this even further, many law school courses don’t cover it either. It’s not that the Federal ERISA law is secret, just that there are other things to go over that are deemed more important. However, we know that this is important to your provider network.
Throughout the merger process, there’s so much going on that your CBO (central billing office) isn’t able to keep up with all of the old claims. When their appeals are exhausted, it’s time to call in the experts, like those at ERISA Recovery. We know how to get those unpaid and underpaid claims covered in ways that your CBO (central billing office) employees don’t. And we understand that the best time to work on getting them cleared up is before that merger goes through. You need to start with a clean slate.
Don’t allow your CBO (central billing office) employees to write off those unpaid and underpaid claims that emerge during the merger process. Instead, contact us, ERISA Recovery. We know the ins and outs of Federal ERISA Appeals and can get that money for you. Your merger will go much more smoothly if you know that those claims will be cleared up. All that we need from you is some paperwork, and our employees will take care of the rest. Are you ready to see how we can help? If so, call us at (972) 331-4140. To make it easier for you, we also have a contact form on our website. Just fill it out, and you’ll hear back from one of our experts.