In the event that a provider is severely non-compliant or abusive, you will want to speak with your manager or supervisor immediately.
Remember to outline some of the following:
- List of items that the provider is non-compliant in and how you recommend correction of the issue.
- Coding
- Sending charges consistently
- Providing EOBs
- The associated revenue
- Ask: How much money is being effected by the provider's non-compliance?
- Steps to become compliance
- Ask: What steps can the provider take to become more compliant?
- Expected resolution
After approaching your lead with each of these items, your lead may suggest that you complete a RCM Non-Compliance letter. It has been attached for your review.
Please forward a completed version of this letter to your Manager and copy the VP of Client success. Your VP and manager MUST approve your letter prior to it being sent to the customer.
Remember to open up an At Risk ticket in Hubspot AND attach your letter to that ticket. These letters should be sent certified to your practice/ provider once approved. A copy of that certification should also be loaded to the respective at risk ticket for documentation purposes.
It is recommended that you set a "TASK" within your at risk ticket as a reminder to check on a response from the practice after the days allotted in the letter to ensure compliance/ responsiveness and if none the next appropriate action is then taken per the escalation path.