Managed Care Early Intervention Program
Upon referral, RTR will review each account. Expediting claim time, accounts are automatically grouped by insurance carrier. Our staff will quickly seek to obtain any additional information the carrier needs from the patient, insured, and/or hospital and will re-bill the account when all requests are satisfied.
If the managed care carrier does not respond to our follow-up efforts and/or billing, the patient will be advised of this in a letter encouraging them to contact the carrier and keep us informed as to their progress. Note that for patients insured by Medicare, there will be no patient dunning.
If the claim is rejected, or the balance represents a deductible and/or co-insurance responsibility, then we will do the following based upon the hospital’s instructions:
- 1. Advise the hospital so that its records can be adjusted accordingly and return the account; or
- 2. Advise the patient accordingly, and request payment in full. If the patient is unable to make payment in full, we will then seek to make payment arrangements in accordance with the hospital’s instructions. Cognizant of client instructions, payment arrangements will be attempted with patients unable to pay in full. Encouraging future payments, account holders will be provided with self-addressed envelopes and contacted to address any anomalies in the payment schedule. If the patient refuses to make acceptable payment arrangements, then the account will be reviewed by a Manager to determine if the account should be closed, or forwarded for litigation pursuant to the hospital’s instructions.
Medicaid Managed Care Follow-Up
The Client will be forwarding accounts within 20 days from the date the Client bills the account for the first time. Upon referral, RTR will review each account. Expediting claim time, accounts are automatically grouped by managed care carrier. Our staff will quickly seek to obtain any additional information the carrier needs from the patient, insured, and/or hospital and will re-bill the account when all requests are satisfied. Accounts with rejected claims will be returned, with notice, to the hospital.