Rule 1. Automate all procedures wherever possible. There are systems that can automate all the procedures the provider must use. Look for them. They will save you money in operations and in collecting your invoices, and your Claims will be paid sooner.

Rule 2. Use utmost care in verifying the terms of the insurance policy. Always confirm in writing the terms obtained on the telephone verification This is self-explanatory, and obvious. Yet although many providers do verify the policy, few follow up by sending a letter to the insurance company confirming the verification.

Rule 3. Gather and send to the payers all documents. These include: invoices, contracts with patients, assignment of benefits, doctor's certificate of medical necessity, doctor's plan of treatment, nurse's notes and time sheets, as well as delivery receipts for drugs, equipment and other supplies. Never destroy any of the aforementioned documents until the bills are paid in full.

Rule 4. Keep an up-to-date research file on each illness the provider treats. This information is important because the insurer may question the necessity of the treatment.

Rule 5. Keep an up-to-date research file on prices and rates in your area, These data are important if the insurer challenges your bill with an assertion that the rates charged are not usual and customary. Blue Cross and Blue Shield and other major insurers, in various parts of the country, have set up artificial rates for home infusion, and are challenging the prices of infusion therapy providers.

Rule 6. If payment is not made in full, always request an appeal, and request it immediately. Make your appeal part of the operating system for invoices. The appeal should be requested immediately as the bill is rejected in whole or in part. But you must verify that the unpaid part has been paid. There is a short time limit. All that needs to be done is to send a letter, with a copy of the explanation of benefits, requesting an appeal of the payments listed on that document.

Rule 7. Send all documents to the appeals administrator with the research materials on the illness, and the prices and rates in the area, This rule and the following one are essential to every successful appeal.

Rule 8. Request from the appeals administrator copies of all documents the pay or has submitted for withholding payment or rejecting the appeal Sometimes the insurer uses a doctor as a consultant, and he has a medical opinion favorable to the insurer, but it is sometimes not backed up by the medical Literature. Your research material, and added input from the attending physician should help you win your case.

Rule 9. Start your suit immediately. Give your lawyer all the documents used on the appeal. If the appeal is denied, act immediately. Sometimes it takes a year or two from the time the invoice is sent until the suit is initiated. There are restrictions in each state and in each insurance policy on how late suits can begin. Do not let the time lapse.

Rule 10. Choose a lawyer or collection service that will supply the names of all its owners. Federal statutes require that you list the names and addresses of any employee or agent (collection agency) of a provider who has been convicted of Medicare and Medicaid fraud. If the owner of the collection agency has been convicted of fraud, it must be reported to the Health Care Financing Administration.

The penalties for failure to report are very severe and can set in motion events that can put a health care company out of business. Also, collection agencies have been known to execute releases without authority. By this gesture the agency keeps secret a settlement from the provider. Do not allow the collection agency to sign releases to the insurance company or to endorse settlement checks.

Rule 11. Choose your own Lawyer. If that is not possible, establish direct contact with the lawyer who files the case. He is your lawyer. Guide him. There are some insurers who do not take kindly to tactics by overly aggressive lawyers.