Making health care providers strong by collecting overdue insurance payments.Attorney Clinton Michael (Clint) Hodges just spun off from his Encino law practice a new company, Medical Recompense RECOMPENSE. A reward for services; remuneration for goods or other property. 2. In maritime law there is a distinction between recompense and restitution. (q.v. Co., to collect bills owed by third-party insurers to health maintenance organizations and other providers. "HMOs, PPOs (preferred provider organizations pre·ferred provider organization n. Abbr. PPO A medical insurance plan in which members receive more coverage if they choose health care providers approved by or affiliated with the plan. ), hospitals, medical centers and group medical practices are losing an estimated $4.6 billion every year because some insurance carriers are not paying what they owe," he declared. Yet 87 percent can be collected given the right set-up, Hodges assured, to add typically 0.5 percent to the bottom line of managed health care providers. PPOs, HMOs, etc., are bound contractually to provide medical services to members, he explained, even if those services were required because of members' on-the-job injuries or insured car accidents. MedReCo seeks to collect from insurers that have third-party liability -- such as workers' compensation workers' compensation, payment by employers for some part of the cost of injuries, or in some cases of occupational diseases, received by employees in the course of their work. and car liability insurance carriers -- for the cost of applicable medical services provided by health care provider clients, Hodges said. The larger the HMO HMO health maintenance organization. HMO n. A corporation that is financed by insurance premiums and has member physicians and professional staff who provide curative and preventive medicine within certain financial, , PPO PPO abbr. preferred provider organization PPO Managed care Preferred provider organization, see there Infectious disease Pleuropneumonia-like organism, see there , etc., he asserted, the more likely it is to have significant funds owing from such sources, which is an important reason health care costs have been escalating so steeply. Yet few of even the largest health care providers have in-house staffs to identify such collection opportunities, Hodges, 55, indicated. MedReCo's system starts, he said, with giving a health care provider client a six-question checklist for intake clerks to ask patients to identify those whose files should be referred for further handling. Using a computer software program Hodges and associates developed over seven years, he said, MedReCo follows up on the referred cases. MedReCo then contacts the liability carrier having the primary responsibility and imposes a statutory lien that obligates the insurer to reimburse the care provider client for its services, Hodges said. Although MedReCo is just getting under way, Hodges projected it will have 10 of the larger Southern California Southern California, also colloquially known as SoCal, is the southern portion of the U.S. state of California. Centered on the cities of Los Angeles and San Diego, Southern California is home to nearly 24 million people and is the nation's second most populated region, HMOs under contract within a year. That projects out to between $6 million and $100 million a year with MedReCo's share slightly less than a third of the collections. And in a year or two, Hodges continued, he plans to open a MedReCo satellite office in Northern California Northern California, sometimes referred to as NorCal, is the northern portion of the U.S. state of California. The region contains the San Francisco Bay Area, the state capital, Sacramento; as well as the substantial natural beauty of the redwood forests, the northern before expanding through affiliates into Oregon and Washington. |
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