Patient Collection Compliance

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The collection and documentation of deductibles and coinsurance have never been more critical to your treatment center than it is now. On October 24, 2018, President Trumped signed H.R.6 – SUPPORT for Patients and Communities Act into law. The document is over 250 pages long, and while most of it may not apply to your treatment center, there is a specific section which makes waiving deductibles and coinsurance a federal felony with consequences of up to 10 years imprisonment and $200,000 in fines, per incident.

To view the exact verbiage, please click here: § 220. Illegal remunerations for referrals to recovery homes, clinical treatment facilities, and laboratories

If you do not wish to read the full document, here is the section that is most relevant:

shall be fined not more than $200,000, imprisoned not more than 10 years, or both, for each occurrence.

“(2) pays or offers any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind—

“(5) a waiver or discount (as defined in section 1001.952(h)(5) of title 42, Code of Federal Regulations, or any successor regulation) of any coinsurance or copayment by a health care benefit program

In the substance abuse and mental health treatment field, unfortunately, it is still common practice to waive patients deductibles, coinsurance, and copays. Most treatment center owners are not properly educated by their billing provider to fully understand the requirements and laws around patient billing and collection. We have found that even when they are aware of the requirements, either their billing provider does not offer this patient collection service as it’s incredibly labor-intensive or it’s deemed to be such a daunting task that it gets pushed aside and forgotten about, hoping never to cause issues one day. Regardless of your situation, if you are not collecting, making a strong effort to collect, documenting all of your efforts and keeping excellent records of the entire process you officially have a severe amount of liability.

The law went into effect upon it’s signing, so if you are reading this now and you have either not been aware of these changes or do not have strict policies and procedures in place to stay compliant with these new regulations, we strongly suggest you start taking it seriously. We understand that not every treatment center is equipped to handle this often uncomfortable financial process with its patients nor do they want to build an entirely new department from scratch, especially one they know very little about. That is why Efficient Optimized Billing (EOB) is now offering our collections compliance service to all treatment centers that wish to stay in compliance with the law. This is a service that we have been offering exclusively to our full-service billing and revenue cycle management clients since our inception in 2016. Given the sudden and unexpected changes, we feel a substantial amount of responsibility to help our community that unfortunately, is mostly out of compliance. We have refined this service over the years to a point where as a treatment center owner and operator, should you choose to hire us for this process, you will have absolutely nothing to worry about.

Our service has been thoroughly scrutinized and proven to be in compliance by successfully passing audits performed by Anthem Blue Cross, Blue Shield, Cigna, United Healthcare, HealthNet, and Aetna. Although we encourage you to seek your own legal advice, EOB has already spent the time and resources going over these new laws in depth and have had our process examined by a well respected legal firm in Orange County that feels this service will almost instantly bring any treatment center owner into compliance with the new laws.

Here are some common mistakes we find treatment centers making.

  • Not collecting or properly documenting the collection of a patient’s deductible upon admission
  • Improperly written promissory note contracts or hardship packet agreements
  • Incomplete financial documents outlining how the billing process works, what the daily fees are and what their patient responsibility is
  • Zero communication or statements sent to the patient about how their insurance is paying and what they are financially responsible for
  • No record or log of any statements mailed or phone calls made in an attempt to collect an owed balance
  • No actual collection attempt or enforcement of promissory notes or payment arrangements


What Efficient Optimized Billing Patient Collections Compliance Service Offers:

  • Library of audit tested and legally approved documents your facility can use upon the admission of a patient (ex: promissory note, payment plan agreement, application for financial hardship, debt settlement agreement, insurance fee schedule, policy for patient financial responsibility, etc.)
  • Implementation of an e-sign process to collect credit card authorizations effortlessly and electronically before admission
  • Internal policies and procedures to implement immediately with your staff
  • Initial staff training for your admissions and intake department on what they need to be doing, saying, and discussing with your patients
  • Quarterly audits to ensure you are staying in compliance with action plans to correct any deficiencies
  • Custom CRM instance where all of your collection efforts will be logged, easily viewable or exported at any time
  • Customized statements and bills sent directly to your patients
  • In-depth tracking of all attempts to collect, including paper mail, email, and phone calls
  • Processing of deductible, copay, and coinsurance payments
  • Transparent reporting of what is being collected
  • A gentle, but effective collections approach that will not ruin your relationship with your patient


How it works and implementation:

  • The implementation process is streamlined and straightforward. You can retain your current billing provider and have our service operate silently in the background.
  • Our service requires no significant changes to your current billing and claims practices. Your cash flow will not be negatively affected. We intend to allow you to operate as you normally would, but with an added layer of security and increased deductible, copay, and coinsurance collections.
  • We will communicate directly with your current billing provider or in-house billing team to receive all the necessary financial information required to bill your patients accurately. We can do this process weekly, bi-weekly, or once a month, depending upon your facilities size.
  • Overall, communication with us can be very minimal. We only require patient names, contact numbers, emails, and to be alerted of new patient admission and discharge.
  • We can integrate with your treatment team to ensure your patients are not triggered or overly stressed by their financial situation. Collections can be a burden for anyone, especially someone in treatment, so we prefer to have some communication to keep everything operatively smoothly, although it is not required.


If you are interested in learning more about our compliance services, please either email or call us at  888-304-8965 to discuss your needs. We would be happy to hear from you and help bring you into compliance for the 2019 year.

39 minute average turnaround time for a completed verification of benefits. Could we do it faster? Sure, but our VOB contains 106 total questions we ask the insurance carrier so you’re not guessing anymore on whether or not you can work with the policy or actually make money on it.
You treat your patients; we’ll get the days authorized and approved to secure payment for services. Our minimum goal for each client you treat is 7 days of detox, 30 days of residential, 30 days of partial hospitalization and 30 days of intensive outpatient. Ready to offer your patients a 90 day guaranteed stay with you?
Relentless. Aggressive. Persistent. Accountable. These words describe the team chasing after your money, and you’d hate to be on the receiving end of their calls. We don’t stop until we’ve extracted every available dollar from your submitted claims. Watch us work in real time with our transparent tracking system available to all our partners.


We’re ready to bring you to the next level
2900 Bristol St, Ste J-205
Costa Mesa, CA 92626

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