Need Some Advice

[jyoung65]

I am working on a client aged claims, and all denials. In my contract I am charging her a percentage of all the claims I recovery.The dilemma is a lot of the patients has not met their deductible, therefore I will not be getting paid, for all my time I invested in the process. All of her patients are Medicare & Medicaid, and they are all on a fixed income. So fair one of the patients has paid their deductible.

I think I need to go back to my client and amend the contract. I need some advice on how I should handle this situation.

Thanks:)

[PMRNC]

I am working on a client aged claims, and all denials. In my contract I am charging her a percentage of all the claims I recovery.The dilemma is a lot of the patients has not met their deductible, therefore I will not be getting paid, for all my time I invested in the process. All of her patients are Medicare & Medicaid, and they are all on a fixed income. So fair one of the patients has paid their deductible.

I think I need to go back to my client and amend the contract. I need some advice on how I should handle this situation.

Thanks:)

Well, I would recommend you take the contract to an attorney or an attorney who helped you with it if that's the case. Ask them for their opinion first.  I know what mine would say because I have in my contract (check yours as well) a clause that states "HRS reserves the right to modify or amend this agreement with 30 days notice, with an exception of client dismissal due to suspicion of or acts of wrong doing by the provider"   In other words.. I can change it with 30 days notice.  If your contract has that clause you can exercise it, if it does not, I think you would need to go to the provider and re-negotiate a new contract with the verbiage you wish to change.  Remember that even with a new contract or an amendment there is no guarantee the client will sign, they also will reserve the right to accept or decline it. If they decline it you can then exercise your right to dismiss them with sufficient notice as per your contract.  Cases like this can work out quite nicely if you just go to the client personally and explain the situation. It's also a good lesson to learn for your next contract. There are always things we all learn from in the same regards. Making mistakes is how you learn

[camedbill]

I would talk to the client, come to an agreement, then fax them an addendum to the contract.  Charge per claim for those that you don't get paid for from insurance for whatever reason (deductible, lapse coverage,  hmo patients sent to you in error, etc)