Medical

Difference between Urgent care, ER, and Hospitals

1. Urgent Care:
   • Purpose: Designed for urgent but non-life-threatening medical issues. Ideal for when you can’t wait for a regular doctor’s appointment but don’t need emergency room services.
   • Conditions Treated: Minor injuries like sprains, cuts that may need stitches, mild to moderate flu symptoms, minor infections, etc.
   • Hours: Often extended hours, including evenings and weekends, but not usually open 24/7.
   • Cost: Typically lower than ER visits.
2. Emergency Room (ER):
   • Purpose: Equipped to handle severe and life-threatening conditions. They are open 24/7 and can provide immediate medical attention.
   • Conditions Treated: Heart attacks, strokes, severe bleeding, head trauma, serious injuries, severe breathing difficulties, etc.
   • Hours: Always open, 24 hours a day, 7 days a week.
   • Cost: Generally higher than urgent care, due to the resources needed for life-saving treatments and the variety of specialists available.
3. Regular Hospital Visit:
   • Purpose: Scheduled visits for various medical needs that are not urgent or emergency. This includes regular check-ups, consultations with specialists, scheduled surgeries, and ongoing treatments.
   • Conditions Treated: Chronic conditions, follow-up visits, elective surgeries, specialist consultations, and more.
   • Hours: Typically during regular business hours, though hospitals themselves are open 24/7 for inpatient care.
   • Cost: Varies based on the services provided, but usually, it’s planned and often covered by health insurance.

Scenario-Based Examples:

1. John’s Sports Injury: John injures his ankle while playing soccer. The pain is significant, but the ankle isn’t deformed, and he can bear some weight on it. He decides to visit an urgent care, where he is diagnosed with a sprain and given a brace and pain medication.
2. Mary’s Chest Pain: Mary experiences sudden, severe chest pain and difficulty breathing. Her family calls an ambulance, and she is taken to the hospital’s ED. There, she is quickly evaluated for a heart attack.
3. Regular Health Check-up: For his annual health check-up, Alex visits his local hospital, where his primary care physician conducts a thorough health examination and routine blood work.

Understanding Urgent Care Center Challenges

Urgent care centers face a unique set of challenges that differ from those encountered by regular hospitals. Here are some of the key challenges:

1. Patient Volume and Flow Management: Urgent care centers often deal with unpredictable patient volumes, as patients walk in without appointments. This can lead to periods of overcrowding or underutilization, making staffing and resource management challenging.
   Example: An urgent care center may experience a sudden influx of patients during flu season, leading to longer wait times and a strain on available staff and resources.
2. Limited Resources and Capabilities: Unlike hospitals, urgent care centers typically have fewer resources in terms of medical equipment and specialist availability. This limitation can affect the scope of treatments they can offer and may require referring patients to hospitals for more comprehensive care.
   Example: A patient with a complex fracture may visit an urgent care center, only to be referred to a hospital because the urgent care lacks the necessary orthopedic specialists and advanced imaging equipment.
3. Staffing Challenges: Staffing in urgent care centers can be challenging due to fluctuating patient volumes. It’s difficult to predict when there will be a surge in patients, requiring a flexible and adaptable staffing model.
   Example: An urgent care center may find it challenging to maintain sufficient staffing on weekends or holidays, times when patient influx can be unpredictable but typically higher.
4. Insurance and Billing Issues: Urgent care centers often face challenges with insurance reimbursements. They need to navigate a complex web of insurance plans, each with its own policies on coverage for urgent care services. This can lead to billing complications and difficulties for patients in understanding their financial responsibility.
   Example: A patient might visit urgent care for a minor procedure and later receive a bill that is not covered by their insurance, leading to confusion and dissatisfaction.
5. Scope of Service Limitations: Urgent care centers are designed to handle non-life-threatening conditions, which can sometimes lead to misunderstandings among patients about the scope of services offered. Managing patient expectations about the type of care they can receive is a continual challenge.
   Example: A patient visits an urgent care center expecting comprehensive cardiac evaluation, but the center is only equipped to provide basic EKGs and must refer the patient to a hospital for more in-depth testing.
6. Continuity of Care: Ensuring continuity of care is a significant challenge for urgent care centers, especially in communicating with a patient’s regular healthcare providers. Sharing patient records and ensuring follow-up care is coordinated effectively can be difficult.
   Example: A patient treated at urgent care for a minor injury may not have their visit details promptly communicated to their primary care physician, leading to a gap in their medical record.
7. Regulatory Compliance: Urgent care centers must adhere to various health regulations and standards, which can be challenging given their limited resources compared to full-scale hospitals.
   Example: An urgent care center may struggle to keep up with the latest healthcare regulations, such as those related to patient data privacy or infection control, which are more easily managed in a hospital setting with dedicated compliance teams.
8. Competition and Market Pressure: There is increasing competition in the healthcare market, with more urgent care centers opening and hospitals expanding their own urgent care services. This competition can impact patient volumes and the financial viability of these centers.
   Example: A new hospital-affiliated urgent care center opens nearby, offering similar services. This competition might lead to a decrease in patient visits to the independently operated urgent care center.
9. Quality of Care and Patient Satisfaction: Maintaining high-quality care and ensuring patient satisfaction in a fast-paced, high-turnover environment is challenging. Urgent care centers must balance quick service with attentive and thorough medical care.
   Example: Due to the high turnover of patients, an urgent care center might receive feedback about rushed consultations, which could affect patient satisfaction and the perceived quality of care.
10. Technological Integration: Implementing and maintaining up-to-date medical technology and electronic health records systems can be a significant investment and operational challenge, especially for independently operated urgent care centers.
    Example: An urgent care center might struggle to fund and implement a state-of-the-art electronic health record system, which is essential for efficient operation and is standard in most hospitals.

These challenges require urgent care centers to be highly adaptable, efficient, and patient-focused to provide effective and timely care while maintaining financial stability and regulatory compliance.

Working diplomatically and amicably with patients has a greater chance of recovery than trying to recover using unethical and overly pressurizing tactics.

Our Strategy for Debt Collection

When a debt collector approaches patients with dignity and respect, it frequently surprises those who hold a strongly negative view of debt collectors. If the collector courteously informs the patient about the repercussions of non-payment and offers various payment options, they are more likely to successfully collect the debt compared to using forceful methods.

The belief that money can be forcefully extracted from patients is a misconception. Adopting this respectful approach also enhances the reputation of medical practices. Our Google reviews reflect this positively; we have a rating of 4.85 out of 5, with 90% of the reviews coming from individuals from whom we have collected money.

Need an experienced medical collection agency? Contact us

Two words that strike fear in the minds of consumers: Collection Agency. Patients worry about getting pressed with collection demands, phone calls, credit history, and possible legal suits. However, thanks to FDCPA regulations, collection agencies must now behave or get into trouble,

Fact 1: If a patient has not paid for 90 days (three billing cycles), the chances that they will now pay their medical bills are nearly zero. They may have piled on more bills too.

Fact 2: Your staff hates calling patients repeatedly to pay these long-due bills, and they can never take the task as efficiently and seriously as a collection agency. Without the involvement of a collection agency, you are essentially looking at almost a 100% loss. Debt collectors talk to people all day long, and they know all the tactics and ways to deal with patient excuses. If staff are not adequately trained in billing procedures and managing accounts receivable, it can lead to inefficiencies and errors.

Fact 3: There are several federal and state laws when you collect medical bills. Yes, there are laws if you want to recover your own money. Without knowing these laws exposes you to potential lawsuits.

HIPPA and Data Security

As part of these federal mandates, debt collection agencies must keep debtors’ information private and secure. Data provided by doctors and hospitals can have personal information, including SSN, DOB, and other sensitive information. All “Personally Identifiable Information” must be protected from fraud, theft, and any other means of being public.

A reputable medical debt agency will know that they must sign a “HIPAA Business Associate Agreement” to agree that they will comply with HIPAA regulations.

Dealing with Insurance Companies

Medical debt collection agencies are not just about going after unpaid patient debt. Doctors often have a nightmare dealing with insurance companies and getting the claim processed in a timely manner.

Insurance companies are legally liable to respond within a few weeks after receiving a collection letter. A collection agency will not generally make phone calls to an insurance company.

Using the same skills they use to settle debts with patients amicably and professionally, these companies can assist doctors and back-end personnel with insurance follow-up.

Experienced medical debt collection agencies have even been known to coerce insurance companies into processing claims quicker than usual.

Conclusion

A collection agency does not have to be a bad thing. The right collection agency will improve your cash flow, without damaging valuable patient relationships.

Hiring a Medical Collection Agency near you has no benefits.

A debt collector does not personally go to collect money from your patients, therefore it is immaterial if a patient receives Collection Calls or Letters that have originated from your city or somewhere from California or New Jersey.

In fact, if you are limiting your search to a Collection Agency located near you, most likely you are missing out on hiring a Collection Agency that could have recovered a lot more money from your patients.

When hiring local services like a plumber or cleaner, location matters. But do you know where your phone or bank calls come from? With debt collection, the agency’s location is irrelevant.

Medical collections require a deep understanding of the doctor-patient relationship. Collections should be handled diplomatically to preserve this bond. Ensure your collection agency is licensed in your state and has both English and Spanish-speaking collectors.

If legal action is needed, most agencies have a nationwide network of lawyers. Contingency fees vary based on the case’s complexity. Agencies must also follow federal laws like FDCPA, FCRA, TCPA, and HIPAA.

In addition to a high recovery rate, check if the agency offers a secure online portal for managing accounts and stopping collections when payments are made. Ask if their call centers are in the U.S. and how they protect patient data with third-party security certifications.

Searching for a “Medical Collection Agency near me” might not get you the best. Look for agencies that offer effective, low-cost demand letters for accounts under 120 days past due, usually around $15 per account.

Medical collections are more vulnerable to lawsuits, so the agency should perform a Litigious Patient check and be fully insured to protect both themselves and your practice.

Transferring accounts to collections is recommended if bills are unpaid after 60-90 days. Most agencies won’t report to credit bureaus until a year has passed due to legal regulations.

Looking for a medical collection agency? Contact us

Medical malpractice insurance covers a hospital against instances where death or great harm are caused. Malpractice insurance is often available through traditional insurance carriers. Before selecting which insurance is best for your firm, it is highly advised to consult a professional medical insurance consultant or institutional risk manager to discuss options. You should also check to see if the state/country of the said hospital has a minimum carrying requirement. In the USA, more and more states are requiring the hospitals have some sort of coverage against this occurrence. There are several different types of malpractice insurance with varying costs. The two most common types of Medical Malpractice Insurance are Claims-Made and Occurrence, but there are a few more that pop up for specific scenarios.

Claims-Made Insurance

Claims-made insurance covers policy holders for alleged acts of malpractice that take place and are reported during the time that the policy is active. This policy will not cover any incidents that are reported after the claims-made policy has expired. These policies tend to have little activity when they are first enacted because claims are often not filed directly after an incident.

Since there is such a long period of time between incidents and reports, there is bound to be some margin of error if the said hospital was to switch malpractice insurance. For instance, if a patient dies in a hospital that is covered under claims-made insurance and is reported after switching to another insurance, then that instance is not covered. To compensate for this said hospital might want to purchase Tail Coverage or Nose Coverage in addition to their new insurance.

An advantage of claims-made insurance is that it is often the most cost-efficient option. They are also advantageous in that you can ensure the risks from services you have provided in the past; meaning you can adjust your policy limits and deductibles to meet inflation. On the other hand, these policies tend to be complex and difficult to work with.

Tail Coverage

If one chooses to cancel their claims-made policy or switch to another insurance there will be an uncovered period of time where you are not covered. Tail coverage covers a firm from any incident that is not been filed until after said claims-made policy is no longer covered. This only applies to claims-made policies and not occurrence policies.

Tail Coverage will protect your prior acts even after you cancel your claims-made insurance. The cost for tail coverage can be difficult to pinpoint, so it is best to discuss it with a professional medical insurance consultant before making a decision. Typically, insurers will charge a fixed percentage of your professional liability insurance policy cost; this is often somewhere between 100-300% of your final premium. Keep in mind that tail coverage tends to cost more depending on how far back the incident goes. The cost of tail insurance can go up to twice the typical malpractice premium.

Nose Coverage

When you set up claims-made insurance, the first date of coverage is called the retroactive date. This date excludes you from any claims that happen before it. Nose Coverage, or Prior Acts Coverage, is coverage that allows you to change your retroactive date to the start date of your new coverage. Nose coverage provides protection for instances prior to your past policy. Tail coverage only applies to your incidents that happened when you were covered, yet was filed after your coverage expired. It is important to remember this distinction when changing insurances.

Occurrence Insurance

Occurrence coverage will cover you any time after the policy has been enacted. If an incident was to happen during the policy, it will still be covered if reported after the policy is retired. Likewise, there is no need for things like tail insurance, since future is always covered from past mistakes. There is also no need for prior acts coverage is needed when changing insurance.

Occurrence seems like the optimal policy to go with, but it is not frequently offered by employers. In addition to that, occurrence policies are often more expensive than claims-made insurance. Cost tends to not be a huge issue when selecting insurance, it is more so what works best for your business.

Cost of Malpractice Insurance

It is difficult to say what the cost of your insurance will be without getting a quote. It is crucial to discuss payment options with a professional medical insurance advisor prior to making a decision involving a new medical malpractice policy. There are many variables that will influence your rates, such as insurance type, location, practice, number of employees, and liability. For example, on average malpractice insurance can be approximately $13,000 in Minnesota, but it would cost over $22,000 in California, Surgeons tend to pay more because they have more liability than the average dentist; a surgeon has a higher risk of incident. In addition, occurrence insurance is far more expensive than claims-made. This might be because occurrence must cover a wider timeframe. The typical malpractice insurance will range anywhere between $5,000 to $20,000 annually.

Sources used
https://www.acponline.org/about-acp/about-internal-medicine/career-paths/residency-career-counseling/guidance/medical-malpractice-insurance
https://www.eqgroup.com/occurrence_claimsmade_explained/
https://www.gallaghermalpractice.com/blog/post/going-bare-are-doctors-required-to-have-malpractice-insurance
http://www.camedicalmalpractice.net/purchasing.htm
https://www.trustinsurance.com/resources/articles/malpractice-insurance-101-claims-made-vs-occurrence-coverage
https://www.insureon.com/insurance-glossary/tail-coverage
https://www.insureon.com/insurance-glossary/nose-coverage

Having a Medical Collection Agency near you has no advantages.

A debt collector does not personally go to collect money from your patients, therefore it is immaterial if a patient receives Collection Calls or Letters that have originated from your own city or somewhere from California or New Jersey.

In-fact if you are limiting your search of a Collection Agency located near you, most likely you are missing out on hiring a Collection Agency that could have recovered a lot more money from your patients.

When you need to hire a plumber or a cleaner you go local, but do you know from which city do your monthly Electric or Phone statements are generated. Do you know from which city of America do you get a phone call regarding your Bank Account or regarding your upcoming Flight Status. Do you even care? Debt collection is one of the activity where physical location of the agency really does not matter.

Medical Collections is very tricky, the agency handling your accounts receivable should clearly understand the delicate nature of doctor-patient relationship. Collections should be made in a diplomatic, systematic and amicable manner, in an attempt to preserve the doctor-patient relationship.

Important requirement – Your medical collection agency should be licenced to collect in your state, and apart from English speaking collectors, they should have Spanish speaking debt collectors as well.

If all direct collection efforts fail and a lawsuit is advisable, then nearly all Collection Agencies have a nationwide network of experienced lawyers in pretty much every city of America. It is a part of their standard collections process. Contingency fees is disclosed in advance depending on the complexity of the case.

All medical collection agencies are required to follow all federal and state laws like the Fair Debt Collection Practices Act (FDCPA), Fair Credit Reporting Act (FCRA), Telephone Consumer Protection Act (TCPA) and Health Insurance Portability and Accountability Act (HIPAA) guidelines.

Apart from a higher recovery rate, ask if the collection agency has an online portal where you could submit new accounts, run reports and stop the recovery process of an account where a payment has been received. Are their call centers located in USA or in a foreign country. What all steps do they take to protect the personal data of your patients and if they have any 3rd party security certificates to prove that.

Bottom-line, if you are looking for a “Medical Collection Agency near me“, you will likely miss hiring the best debt collection agency in medical field.

In Medical Collections, demand letters sent by a Collection Agency are extremely effective and a low cost solution. Ask your collection agency if they offer Collection Letters service or not, they cost roughly $15 an account. Best suited for accounts less than 120 days past due.

Medical collections are relatively more prone to legal action from aggravated patients. To protect your medical practice from running into these lawsuits, your Collection should perform Litigious Patient check. It means if the patient has a history of suing Small Businesses or Medical Practices then the agency should appropriately advice you. Moreover, the agency should be fully insured to protect them-self and your practice in case a lawsuit is filed by a patient.

It is advisable to transfer an account to collections if a patient has not cleared their medical bill within 60 to 90 days and your own staff has not been successful to recover money during this time-frame.

Looking for a medical collection agency? Contact us.