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Assignment of Claims to Health Care Providers

Seems like a simple concept doesn’t it? Amazingly, so many practices just fail to get all of the information signed and in place.



I often run into practices where the money is going to the patient and not to the provider. This is the results of one side of a two sided coin. The one side is that the provider’s staff did not get the assignment signed and therefore cannot accept payment from the insurance company. The other side of the coin is that the medical billing staff has not properly set up the software to notify the insurance company that the assignment is on file. Either way, the practice is missing out on money it should collect.

There is, however, a third possibility. Some insurance companies simply ignore the assignment. In one seminar I attended, I was told by an insurance representative that it happens more that doctors want to admit and that in reality it was a very simple matter to fix. You see, once and assignment of benefits has been signed, the physician now has a codicil to the agreement between the patient and the insurance company. The insurance company representative went on to tell me that the insurance company had a responsibility to honor that codicil.

His suggestion, call the insurance company and tell them that you have the assignment and direct them to forward a payment to you. At that point they are going to say they have already paid the patient. His direction to me was, that is fine, you get your money back from the patient, you have been directed to pay funds directly to this practice. At that point the insurance company may add some other element to the equation, but it is of no consequence to the provider. They are likely to say that they will get a check out within the next two weeks. His instructions to me were to simply say, I am not waiting two weeks. I do not have to wait any time at all. You have a direct legal responsibility to make payment to this practice, however, I am in a good mood today and will give you 48 hours to get this practice paid before the matter will be turned over for prosecution.

Fortunately, I have never had to use the scenario, but it is something to bear in mind when dealing with those incalcitrant insurance companies.

The Wynn Group, Inc was founded by Nat Wynn in 1996 dedicated to helping physicians with medical billing and practice management by allowing them to focus on their patient while The Wynn Group focused on making sure each and every claim got paid. Visit us here.

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