When it comes to coordinating reimbursement from multiple organizations, PV Kent & Associates has what it takes. Our specialists understand how government and commercial insurers interact with motor vehicle insurance, workers’ compensation plans, and Veterans Administration coverage. They know the billing rules and regulations inside and out, so they can ensure that payers live up to their responsibilities despite the many opportunities for denying claims. Our Liabilities Account and Veterans Administration teams carry out the timely action, meticulous follow-up, and proper coordination of benefits (COB) that are essential to securing prompt payment.

Motor Vehicle Claims Management
As a no-fault state, Massachusetts has instituted procedures that often makes it difficult to collect payment from motor vehicle insurance companies in combination with state, Medicaid, and/or commercial insurers. Given all these companies and agencies, claims management can be complex and time sensitive. It’s extremely difficult for healthcare providers to coordinate all the necessary steps and identify the party responsible for payment at any given time. Kent’s Liability Accounts Department is in an ideal position to drive claims through the process productively.

Kent’s services are most effective when clients refer motor vehicle accident claims to us immediately upon patient discharge. At that point, our legal assistants:

• Screen the patient to obtain and verify all health insurance information
• Use motor vehicle registration software to obtain and verify auto insurance

   information
• Help patients file Personal Injury Protection (PIP) applications
• Submit conditional bills to appropriate healthcare insurers to meet filing

   limits, as appropriate
• Notify MassHealth of auto information via the web site, as required by the

   Office of Medicaid's Hospital RFA (Request for Applications)
• Coordinate benefits among other insurers, including commercial companies,

   Medicaid agencies, PIP, MedPay, and/or bodily injury coverage carriers
• File liens, when necessary and appropriate
• Call in Kent attorneys to enforce liens and represent providers before

   administrative or judicial bodies

Liens
Our Liability specialists can file hospital liens to protect our clients’ legal interests. This process notifies all interested parties of the outstanding obligation and sets the expectation that payment will be made, placing the healthcare provider in a more secure position pending resolution and settlement.

While many healthcare providers do not place hospital liens, Kent deals with cases like this every day. Our Liability Accounts department serves notice of the liens, coordinates benefits upon receipt of payment, and provides information (e.g., certified itemization of bills) to the responsible payer, as required by law.

They coordinate, mediate, and negotiate settlement and — if all else fails — litigate. This course of action increases the likelihood that that the healthcare provider will receive the full payment due for the goods and services provided. It also increases the likelihood that their hospital liens will be honored in the future.

Workers’ Compensation Claims Management
In the case of an on-the-job injury, the health insurers payment responsibility varies based on several factors. In these instances, healthcare providers must secure payment under the Workers’ Compensation program before turning to other payers.

Kent’s Liability Accounts Department has years of experience pursuing claims with workers’ compensation and health insurance organizations and is prepared to coordinate benefits to maximize reimbursement consistent with applicable rules and regulations. The group understands the mind set of these organizations, as well as the laws and procedures that support smooth processing and payment.

Accuracy is a critical component of Workers’ Compensation claims. Frequently, the carrier denies charges on the basis that the provider’s services were unrelated to the injury, that the injury was unrelated to work, or that services rendered were excessive or unauthorized. Our Liability Department routinely challenges denials and payment rates, if the Workers’ Compensation carrier denies the claim or does not reimburse the healthcare provider correctly.

By producing detailed, accurate, and timely documentation, Kent’s specialists avoid this kind of erroneous denial and subsequent delays. They also perform all necessary follow-up to pursue proper payment. In addition, our attorneys represent our clients before administrative or judicial bodies. When necessary or appropriate, they seek remuneration from Workers’ Compensation insurers and the Department of Industrial Accident (DIA)Trust Fund.

Veterans Administration Claims Management
The Veterans Administration (VA) employs an archaic claims system and a convoluted processing and appeals scheme. As a result, many claims generated by healthcare providers are denied payment for erroneous reasons and sometimes even lost completely. In contrast, PV Kent & Associates clients enjoys a 66% collection rate from the VA. We credit this high level of success to our perseverance, familiarity with applicable processes and procedures, and proven strategies for encouraging payment of VA claims.

We exploit the power of our automated collection/tracking/scheduling system to submit claims and follow up at every stage — in real time — encouraging the agency to deliver payment for services rendered. Specifically, we:

• Handle issues specific to inpatient and outpatient services
• Retrieve medical records in accordance with VA requirements
• Resolve issues surrounding lack of authorization for emergency services

• Deal with recurring "Millennium Bill" denials and related issues
• Ensure consistency and accuracy of diagnosis and procedure codes
• Appeal denied claims
• Perform legal reviews
• Request hearings
• File complaints with the federal courts when appropriate

• Are prepared to file appeals to the United States Court of Appeals for

   Veterans Claims