FAQ
Healthcare Law
Isn’t the Gibson Firm just another collections agency?

No. The Gibson Firm is a law firm whose attorneys are members of The Georgia Bar Association. We are not collections agents, nor do we handle cases in such a manner. Our clients are entitled to all of the protections afforded under the rules of attorney client privilege and our cases are handled individually based on legal merit.

Our services extend beyond those of a collections agency: we advise our clients of their legal rights and protections; we may initiate law suits and represent our clients in a court of law, we assists our clients in the negotiations of favorable, legally binding settlements.

What is the advantage of using the Gibson Firm rather than a collections agency?

When unpaid / underpaid claims are sent to a collections agency, the agency has limited options for pursuing payment. Most agencies target the patient, often the payer with the least financial resources. Collections agencies do not understand the complexities of ERISA or insurance law and are usually prohibited from retaining an attorney on a referred matter. Many will claim a fee if you later recall and refer the matter to an attorney.

Matter of this nature should be in the hands of an attorney as soon as you have exhausted all internal efforts to collect and appeal. Group Health Plans and large insurers rarely pay any attention to a case unless an attorney is involved and a lawsuit is an option. The Gibson Firm has a strong record of resolving matters and avoiding expensive litigation. However, the ability to so act brings the payer’s to the table. Collection agencies cannot do that.

What advantage does The Gibson Firm offer over handling the appeals internally?

The Gibson Firm is dedicated to helping providers fight unfair denials and underpayments of claims by insurers and group health plans. Our practice solely involves provider representation and we are experts in healthcare claims reimbursement law, ERISA and Medicare Secondary Payer statutes.

The vast majority of payer denials are based on the payer’s internal procedures, vague, “favorable” contract language, and perceived loop-holes; without proper consideration for applicable state and federal statues and case law. Our team of analysts thoroughly examine the records of each individual case and work with our attorneys to prepare appeals that pinpoint payer errors and present precise legal arguments to rebut payer actions and secure proper payment of your claims.

Furthermore, The Gibson Firm will work with you and your staff, providing free training. This not only aides our efforts when working on your referred cases, but empowers you to handle many situations in-house and decrease improper denials and the need to refer accounts to The Gibson Firm.

When Should I Refer A Case To The Gibson Firm?

If the claims remain unpaid / underpaid after roughly 60 days, and your staff has already sent demand or appeals letters and made calls to the payer, it is time to refer the matter to The Gibson Firm. Reimbursement law is complex, with numerous deadlines and appeals requirements. Time is working against the provider and the payers know this. Refer the matter without delay.

Should I refer claims to The Gibson Firm if the payer states Medicare should be primary?

The rules involved in Medicare coordination of benefits are so complex that collection agencies are not equipped. Additionally, few attorneys are familiar with the Medicare rules. Issues involving Medicare coordination of benefits and reimbursement should be in the hands of an attorney who specializes in such matters, like the attorneys at The Gibson Firm.

What documentation does The Gibson Firm require to work on our claims?

• All claims (UB-92/04’s) for the dates of service at issue with your usual and customary charges for the services provided.
• Proof of verification of benefits and certification or authorization of services.
• All denial notices, explanations of benefits, denials of prior appeals, request for refunds, and records of recouped or off-set payments.
• All correspondence (emails, letters, appeals, call notes, other) between the provider and insurer, patient, employer, TPA, plan attorney, etc.
• Patients insurance card, Medicare card (if applicable), signed Assignment of Benefits and/or assignment of payment.
• Contracts with the insurer, preferred provider organization, special pricing agreements, letters of agreement, or similar documents with the payer, group health plan, insurer, and third party administrator / ASO.

Much of the information you request is patient related and we are required to protect this under HIPAA. How does The Gibson Firm protect this information, the patient and the provider?

All of information supplied by the provider is protected by the attorney – client privilege and does not violate HIPAA. We protect the information internally with the most sophisticated data security systems and restricted access. Records are securely archived and protected from any unauthorized exposure, whether accidental or intentional.

Will we incur any fees or out of pocket expenses?

The agreement you sign with us is a contingency fee agreement. You pay no up-front costs for us to begin working on your claims. After your claims are paid The Gibson Firm receives a portion of the payment as our legal fee. In the rare event that we are unable to secure payment of your claims, you pay no legal fees at all. We only get paid if you receive payment.

The cost incurred to work on and settle the claims are split between The Gibson Firm and the provider. We cover our own operating cost, such as copies, routine postage charges, facsimiles, and office supplies used to pursue your payment. We front the cost of certified postage, filing fees and arbitration fees. Filing fees and arbitration fees are discussed with the client before they are incurred, and must be approved by the client. These fees are rarely incurred and are billed back to the client on a monthly basis.

Do you charge legal fees if there is no recovery on the claim?

No. If we are unable to secure payment for the provider, the provider is not responsible for paying us any legal fees.

Once the claim is paid, how are the monies disbursed to the provider and The Gibson Firm?

Our contingency agreement states that we receive only a small percentage portion of the payment, after the payment for the claim is received. The Gibson Firm prepares detailed invoices on a monthly basis that specify the case information referred (patient name, provider’s patient number, the balance referred) along with the details of the payment we secured (the amount, the date, the payer, and to whom the monies were sent) and our percentage portion for our “fee.”

If the payer pays you directly, you are responsible for paying The Gibson Firm our portion and this will be noted on the invoice. If the payer sends the payment to The Gibson Firm, the money is deposited into a limited trust account, and we send a check to the provider for their portion along with our invoice.

I thought all law firms charge excessive hourly rates and percentages. Why is The Gibson Firm willing to represent providers without up-front retainers and steep hourly rates?

Years ago The Gibson Firm recognized that providers were considerably underrepresented legally in regards to claims denials and right to payment. We became subject matter experts in this specialized area of law, understanding that what was best for the provider was usually what was in the patient’s best interest as well. Since then we have recovered millions of dollars in unpaid / underpaid claims for our provider clients, ensuring that providers are able to continue their high standards of care and invest in technology to improve patient care long term.

Under existing laws, the patients are most often responsible for pursuing appeals when providers are unfairly denied payment, or have rightful payments taken back. Unfortunately, patients rarely have the resources to secure proper legal representation, and often unable to due to failing health. Payers, well financed and politically connected, have fought to marginalize the provider’s ability to secure proper payment if the patient is unable to lead the effort.

The Gibson Firm intimately understands the laws that do exist to protect providers and effectively uses them to contest unfair denials. Our success has afforded us the opportunity to increase our client base and reduce our fees.

Do you handle matters not related to unpaid claims, such as payer refund demands, and what do you charge for these services?

The Gibson Firm handles a variety of provider related legal issues beyond unpaid / underpaid claims. If properly and timely referred, The Gibson Firm can protect providers from payer demands for refund and unjust offsets and recoupment. Further, The Gibson Firm represent’s provider’s in other payer matters, such as special pricing agreements. These services are provided at a low hourly rate, or on a fee for service basis, agreed to in advance.

The Gibson Firm has successfully contested numerous payer demands for refund, helping our clients protect and retain hundreds of thousands of dollars in properly paid claims, with only a minimal hourly fee investment.

How much time is involved in pursuing the matter; and when can we expect to be paid?

Quickly referring the matter to The Gibson Firm, and including all of the requested documents is essential to being able to quickly work the case. There are numerous laws regarding time frames for appeals, payment look back, recoup periods and statues of limitations. We will work with you to identify what to look for to know when to refer a case. We usually begin working on your referral within 48 hours of receiving it.

Time to payment may be widely variable and is dependent on numerous factors that we may not be able to control. As a rule, based on existing appeals and notification law, 3 months is a minimum amount of time required, with most taking longer. In rare instances, or when litigation may be unavoidable, it may take much longer. Therefore, to address client concerns we provide detailed quarterly status reports, listing each case, the date it was referred, the balance referred, the amount we believe we can recover, and the current status.

Once we have reached settlement, or persuaded a payer to reconsider its benefit determinations, payment usually follows within 2 to 4 weeks.