Insurance Claims Resolutionand Self-Pay Recovery

Spend more time with patients,and less time worrying about receivables.

Transworld Systems Inc.

• In the past 5 years, we have recovered $2.4 billion for our clients

• Over 30 years of experience recovering slow-paying and delinquent accounts.

• More than 120 offices across the United States.

• “ Transworld gets credit for the highest recovery rate in the industry.”

- Barron’s

We’re in the business of profit recovery. We lead the industry in providing medical practices with better tools for recovering slow paying patient accounts and expediting reimbursement from insurance companies.

Time is not on your side 80% of all revenue for

most hospitals and medical practices comes from insurance claims filed electronically or manually.

Delays in payment cause frustration and restrict cash-flow.

GreenFlag Insurance Resolution Recovery is a revolutionary new tool to assist in the rapid recovery and resolution of these claims.

Symptom:Delay in claim resolution

Possible Causes:• Incorrect information• Missing codes, signature etc.• Money applied to deductible• Insurance checks released to patients• Insurance companies simply holding on to your

money as long as possible• “Claims never received”• Claims held in “Review”

Internal complications...• Rising internal recovery costs and FTE

expenses• Continued depreciation of old claims • Coordination of benefits with primary or

secondary provider• Billing staff tendency towards concentration on

current claims after numerous attempts to recover older claims have failed

• Continued restriction of cash-flow

Phase One

Day 1-30

31-60 61-90 91-120 121-150 151-180 181-210

HCFA1500 or

UB92Sent

TelephoneCalls or

SendTracers

TelephoneCalls or

SendTracers

TelephoneCalls or

SendTracers

TelephoneCalls or

SendTracers

TelephoneCalls or

SendTracers

TelephoneCalls or

SendTracers

$0.50 $2.75

$1.25

$2.75

$1.25

$2.75

$1.25

$2.75

$1.25

$2.75

$1.25

$2.75

$1.25

Typical In House ProceduresInternal Cost $20 - $27/claim

Two-Phase ApproachDay 1-

3031-60 60 81 95 109 123

HCFA1500 or

UB92Sent

TelephoneCalls,

Refiling

SendTracers

TSI’sFirst

Demand

(30 daydisputeclause)

TSI’sSecondDemand

(statestatute

reference)

TSI’s ThirdDemand

TSI’s

NationalClaims

Manager

TSI’s

FinalDemand

in-house

1 - 3

in-house

4 - 6

HIGHEST POSSIBLE RESOLUTION

LOWEST INTERNAL COST

Why GreenFlag Profit Recovery?• Insurance carrier by-laws and internal policies

typically require immediate response to our licensed third party contacts.

• Our third party demand moves the responsibility for the claim from a clerk to a supervisor, who settles the claim more quickly.

• Our average fixed fee of less than $10.00 per claim allows you to utilize this unique service on claims as early as 30-45 days past-due.

Claims you can submit:• Commercial

Insurance• Managed Care Plans• HMO’S• PPO’S• Medicare• Workman's

Compensation

Remember:• It is not a matter of if

insurance will pay, but when insurance will pay.

• GreenFlag Profit Recovery reduces your internal costs and lowers response time, which works to reduce the age of your receivables.

The results speak for themselves

• A surgical hospital submitted 265 claims totaling $622,000 to Transworld. In 60 days we recovered over $400,000 at a total cost of $2,120.

• A large non-profit hospital assigned 120+ old day claims to Transworld totaling $584,000. We resolved and recovered over $385,000 in 75 days.

How do you benefit?• Using GreenFlag Profit

Recovery at 30-45 days allows your staff to focus their attention and efforts on claims in the 0-30 day window. This reduces the number of claims reaching 60 days.

• Quicker resolution of claims means patients get billed faster for their share of the balance, reducing the number of outstanding self-pay issues.