Receivables recovery in the healthcare sector

Two streams, not one

The first stream is receivables with insurers or claims administrators. These are often not a refusal to pay at all, but a rejection or partial deduction for procedural or technical reasons: coding, prior authorisation, or scope of cover.

The second is amounts owed directly by patients or by companies that have contracted for staff healthcare, which behaves much more like an ordinary commercial claim. Treating both streams the same way is the single largest source of wasted effort in this sector.

Rejections, deductions and what they do to debtor ageing

The balance shown in the ledger may contain rejected claims that were never resubmitted, partially deducted claims that were never contested, and claims still inside the review cycle. These are not one category.

Practical work therefore starts by classifying the balance: what is still an administrative matter, what has become a contractual dispute, and what is plainly due and unpaid. That classification alone frequently changes the estimate of what is realistically collectable.

Confidentiality and patient data

A financial claim does not need a patient's medical file. What is normally required is the financial and contractual material: the network agreement or contract, the claims statement, rejection or deduction advices, the statement of account, and correspondence with the payer.

We ask for the minimum documents the file needs and treat them as confidential. Where a document contains data the claim does not require, redacting it before sharing is sound practice.

Documents usually required

The contract or network agreement with the payer and the agreed tariff; the schedule of submitted claims and their status; rejection or deduction advices and the reasons given; a reconciled statement of account; and correspondence about resubmission or appeal.

For direct receivables: the contract or employer guarantee letter, the invoices, evidence that the service was provided, and any acknowledgement of balance.

How we handle a healthcare provider file

We review and classify the balance, identify the portion that can genuinely be claimed, then approach the payer or debtor professionally and on the record. The objective is usually a written reconciliation of the balance followed by a payment plan, because reconciliation is what ends the argument over figures.

Where an amicable outcome is not reachable, we explain the appropriate step and coordinate with licensed lawyers or the competent authorities within the scope of our licence.