Representative setting: Two-location behavioral health provider
Assessment conducted: March 1–7, 2026
Prepared: March 10, 2026
This fictional example demonstrates the structure of a Follow the Number finding. The account facts and review dates are hypothetical. It does not describe a client engagement or GAC result.
Follow the Number: Sample Assessment
Question Examined
Before admission, during care, and after adjudication, does each patient’s record show what they were told about their financial responsibility, what still needed to be addressed, and who was responsible for following through?
Representative setting: Two-location behavioral health provider
Assessment conducted: March 1–7, 2026
Prepared: March 10, 2026
This fictional example demonstrates the structure of a Follow the Number finding. The account facts and review dates are hypothetical. It does not describe a client engagement or GAC result.
Question Examined
Before admission, during care, and after adjudication, does each patient’s record show what they were told about their financial responsibility, what still needed to be addressed, and who was responsible for following through?
This example assumes a review of pre-admission calls, instant and live benefit verifications, financial agreements, account notes, and claim, payment, and statement histories. The review is limited to these five accounts and the handoffs before admission, during care, and after adjudication.
Defined Sample
5 patients (3 out of network / 2 in network) whose claims had fully adjudicated and produced a posted patient-responsibility balance.
Defined Sample
5 patients (3 out of network / 2 in network) whose claims had fully adjudicated and produced a posted patient-responsibility balance.
This example assumes a review of pre-admission calls, instant and live benefit verifications, financial agreements, account notes, and claim, payment, and statement histories. The review is limited to these five accounts and the handoffs before admission, during care, and after adjudication.
Before Admission
Review of each patient’s pre-admission process established the following:
Patients A & B (OON) were appropriately instructed that their deductible would be due. However, due to the urgency of the situation, they were told to proceed to the facility for admission and that finances would be discussed once their heads cleared.
Patient C (INN) was told that they would not owe anything because the instant verification showed that their policy was fully satisfied.
Patient D (INN) was informed that his policy required a specific copay based on the required LOC. Aside from that copay, his policy would cover 100% of the cost.
Patient E (OON) was clearly intoxicated. While his benefits were discussed, he was most certainly not in any condition to recollect the conversation.
Review of each patient’s pre-admission process established the following:
Patients A & B (OON) were appropriately instructed that their deductible would be due. However, due to the urgency of the situation, they were told to proceed to the facility for admission and that finances would be discussed once their heads cleared.
Patient C (INN) was told that they would not owe anything because the instant verification showed that their policy was fully satisfied.
Patient D (INN) was informed that his policy required a specific copay based on the required LOC. Aside from that copay, his policy would cover 100% of the cost.
Patient E (OON) was clearly intoxicated. While his benefits were discussed, he was most certainly not in any condition to recollect the conversation.
Findings
Four of the five patients were in a condition to meaningfully receive the details of their policies that were relayed to them.
No real attempts were made to collect patient cost share, although some of those decisions were understandable due to the urgency of the specific situations.
Patient C was erroneously informed that his policy was met because of an error in the instant verification system. The live verification only confirmed that the policy was active; it did not confirm what the accumulations entailed.
While finances were discussed, no effective handoff was made to the direct care staff, so no further financial conversation was initiated regarding patient responsibility.
Findings
Four of the five patients were in a condition to meaningfully receive the details of their policies that were relayed to them.
No real attempts were made to collect patient cost share, although some of those decisions were understandable due to the urgency of the specific situations.
Patient C was erroneously informed that his policy was met because of an error in the instant verification system. The live verification only confirmed that the policy was active; it did not confirm what the accumulations entailed.
While finances were discussed, no effective handoff was made to the direct care staff, so no further financial conversation was initiated regarding patient responsibility.
The following was concluded upon reviewing each patient’s account activity:
Each patient signed a financial agreement upon admitting to the facility. However, this agreement was general in nature and did not specifically spell out what the patient’s expected financial responsibility could be.
Patient E was sent to the hospital due to a seizure, 5 days into detox and would not return to the facility upon receiving medical clearance.
Patients A & D completed the program all the way through PHP but neither one was informed of their respective copays.
Patient B’s family contacted him upon receiving an EOB and even though patient acknowledged the benefits read to him prior to admission, he insisted that he was never told and would leave against clinical advice.
Patient C was discharged due to a verbal altercation which nearly escalated to becoming physical.
During Care
The following was concluded upon reviewing each patient’s account activity:
Each patient signed a financial agreement upon admitting to the facility. However, this agreement was general in nature and did not specifically spell out what the patient’s expected financial responsibility could be.
Patient E was sent to the hospital due to a seizure, 5 days into detox and would not return to the facility upon receiving medical clearance.
Patients A & D completed the program all the way through PHP but neither one was informed of their respective copays.
Patient B’s family contacted him upon receiving an EOB and even though patient acknowledged the benefits read to him prior to admission, he insisted that he was never told and would leave against clinical advice.
Patient C was discharged due to a verbal altercation which nearly escalated to becoming physical.
Findings
Patient C was discharged without ever being informed that he was misinformed that there would be no cost prior to admission.
Patient A was only informed for certain that he would owe his deductible which was understandable upon admission. However, he was not informed of his easily calculable cost share coming from copays.
Patient D was only informed of his copay for the detox level of care and was never approached about what his residential and PHP copays would be.
Patient E was a case where the admission rep did everything correctly but the lack of a handoff combined with a hospital transfer led to an unfortunate outcome.
Patient B is an example of how lacking a handoff can sometimes produce an early discharge.
Findings
Patient C was discharged without ever being informed that he was misinformed that there would be no cost prior to admission.
Patient A was only informed for certain that he would owe his deductible which was understandable upon admission. However, he was not informed of his easily calculable cost share coming from copays.
Patient D was only informed of his copay for the detox level of care and was never approached about what his residential and PHP copays would be.
Patient E was a case where the admission rep did everything correctly but the lack of a handoff combined with a hospital transfer led to an unfortunate outcome.
Patient B is an example of how lacking a handoff can sometimes produce an early discharge.
Upon review of each patient’s post adjudication process. The following was established:
Patient B had 6 statements sent out. Patient C had 5 statements mailed out. Patient E had 4 statements mailed out. Patients A & D had 3 statements mailed out.
Patient E’s policy does not accept electronic claims so claims had to be mailed out.
Patient B’s initial batch of claims were denied due to a small discrepancy where the claims were marked as residential LOC, even though the auth was for detox. Once they were re-submitted, they were approved without any issues. The last 3 statements were returned to sender.
Patient A sent in a check for his deductible after the first statement. As of the time of this review, there has not been any response to the last 2 statements.
No response from patient C despite 5 statements being mailed out.
No response from patient D despite 3 statements being mailed out.
After Adjudication
Upon review of each patient’s post adjudication process. The following was established:
Patient B had 6 statements sent out. Patient C had 5 statements mailed out. Patient E had 4 statements mailed out. Patients A & D had 3 statements mailed out.
Patient E’s policy does not accept electronic claims so claims had to be mailed out.
Patient B’s initial batch of claims were denied due to a small discrepancy where the claims were marked as residential LOC, even though the auth was for detox. Once they were re-submitted, they were approved without any issues. The last 3 statements were returned to sender.
Patient A sent in a check for his deductible after the first statement. As of the time of this review, there has not been any response to the last 2 statements.
No response from patient C despite 5 statements being mailed out.
No response from patient D despite 3 statements being mailed out.
Findings
Client does not have anyone on staff specifically responsible for patient-responsibility outreach so no meaningful follow-ups were conducted during care nor post discharge.
Patient A paid the deductible after receiving the first statement, which was the only amount specifically discussed with him. The remaining balance came from copays that were never explained to him, which may explain why the following two statements received no response.
All accounts reflected some sort of activity due to each of them receiving varying amounts of statements. Nevertheless, all the accounts in the sample remain unresolved and lacking in defensibility due to the lack of a consistent record.
Patient B’s first 3 statements made it to the address but the last 3 were returned to sender. There’s no way of knowing what the specific reasons are without some sort of outreach.
Unfortunately, due to the lack of outreach, we can only hypothesize about the potential reasons that the other patients did not pay nor attempt to explore options by calling the number on the statements.
Findings
Client does not have anyone on staff specifically responsible for patient-responsibility outreach so no meaningful follow-ups were conducted during care nor post discharge.
Patient A paid the deductible after receiving the first statement, which was the only amount specifically discussed with him. The remaining balance came from copays that were never explained to him, which may explain why the following two statements received no response.
All accounts reflected some sort of activity due to each of them receiving varying amounts of statements. Nevertheless, all the accounts in the sample remain unresolved and lacking in defensibility due to the lack of a consistent record.
Patient B’s first 3 statements made it to the address but the last 3 were returned to sender. There’s no way of knowing what the specific reasons are without some sort of outreach.
Unfortunately, due to the lack of outreach, we can only hypothesize about the potential reasons that the other patients did not pay nor attempt to explore options by calling the number on the statements.
Recommended Plan of Action
Statements will not create defensibility nor address the revenue leakage as made clear with this sample batch’s findings. Consider one of the following approaches:
Consider hiring a staff member who is well versed with insurance terminology, whose main duty is to follow each patient’s account from start to finish.
Consider hiring a staff member that is compassionate but not well versed in insurance terms and have them act as the “middle man” between the billing team and the patients. This would create a similar workflow to the initial recommendation, although it will be significantly less effective and more time consuming for all involved.
Consider collecting every patient’s deductible up front as well as speaking with them about the OOP max. This is the least recommended option as it will significantly delay any urgent admissions. With this being an in patient LOC initially, this would prove most difficult.
1. Statements will not create defensibility nor address the revenue leakage as made clear with this sample batch’s findings. Consider one of the following approaches:
a) Consider hiring a staff member who is well versed with insurance terminology, whose main duty is to follow each patient’s account from start to finish.
b) Consider hiring a staff member that is compassionate but not well versed in insurance terms and have them act as the “middle man” between the billing team and the patients. This would create a similar workflow to the initial recommendation, although it will be significantly less effective and more time consuming for all involved.
c) Consider collecting every patient’s deductible up front as well as speaking with them about the OOP max. This is the least recommended option as it will significantly delay any urgent admissions. With this being an in patient LOC initially, this would prove most difficult.
The recommended first step is for the provider’s operations to review these findings with admissions, direct care, and billing and assign responsibility for following up on these accounts. Leadership would decide which staffing approach fits the organization and retain authority over payment policies and exceptions.
The recommended first step is for the provider’s operations to review these findings with admissions, direct care, and billing and assign responsibility for following up on these accounts. Leadership would decide which staffing approach fits the organization and retain authority over payment policies and exceptions.
Review each patient’s address as it shows on file and compare it with the one on file under their insurance provider. There are times where people move and never update their address with the insurance. If this is the case then the statements may be going to the address on file with their insurer and their current address may actually be on their chart or their driver license (in case a picture was taken while making an inventory of their valuables upon admission)
Standardize some sort of workflow that makes it abundantly clear who is responsible for the patient’s account. If the above options are not possible then perhaps breaking it down into handoffs might be beneficial (e.g. Admissions hands off the account information to a direct care staff member and that direct care staff member hands off the account to someone else post D/C).
Consider having the admissions supervisor run a fresh instant verification on a separate computer to help catch any one-time errors. The supervisor should also make sure a live verification is completed promptly and includes the deductible and out-of-pocket accumulations. This gives someone responsibility for checking the information and seeing the verification through while the admissions representative focuses on getting the patient admitted.
2. Having the documentation live in one system is highly recommended. In an ideal world, those doing outreach should not have to look into salesforce to see what admissions discussed and Kipu to see what was addressed financially post admission. Only to have to confirm what they see through a combination of Verifytx, Availity, Instamed and collaborativemd, etc.
a) One which every department can access if possible.
b) Another option would be that the information added by Admissions would then be transferred to a system that is accessible by direct care and billing staff.
3. Review each patient’s address as it shows on file and compare it with the one on file under their insurance provider. There are times where people move and never update their address with the insurance. If this is the case then the statements may be going to the address on file with their insurer and their current address may actually be on their chart or their driver license (in case a picture was taken while making an inventory of their valuables upon admission)
Having the documentation live in one system is highly recommended. In an ideal world, those doing outreach should not have to look into salesforce to see what admissions discussed and Kipu to see what was addressed financially post admission. Only to have to confirm what they see through a combination of Verifytx, Availity, Instamed and collaborativemd, etc.
One which every department can access if possible.
Another option would be that the information added by Admissions would then be transferred to a system that is accessible by direct care and billing staff.
4. Standardize some sort of workflow that makes it abundantly clear who is responsible for the patient’s account. If the above options are not possible then perhaps breaking it down into handoffs might be beneficial (e.g. Admissions hands off the account information to a direct care staff member and that direct care staff member hands off the account to someone else post D/C).
5. Consider having the admissions supervisor run a fresh instant verification on a separate computer to help catch any one-time errors. The supervisor should also make sure a live verification is completed promptly and includes the deductible and out-of-pocket accumulations. This gives someone responsibility for checking the information and seeing the verification through while the admissions representative focuses on getting the patient admitted.
What Can Be Surmised
What can be surmised from this 5 patient sample
What can be surmised from this 5 patient sample
Having a staff member handling the patient accounts from start to finish could have helped in the following ways:
a) May have reduced the likelihood of patient B's premature d/c and at best, it could’ve completely prevented it.
b) May have increased the chances that patient E would’ve had their benefits discussed with them once they became coherent.
c) May have increased the chance that patient A would pay the remainder of his responsibility.
d) Regarding patient C’s initial claims adjudicated, a balance coming back could’ve helped the staff become aware of the erroneous verification. This in turn could’ve led to:
i. A live verification where the accumulations were sought.
ii. An increase in the possibility that the patient would be spoken to about what his potential cost share will actually look like.
iii. An increase in the chances that the patient would actually pay some or all of his financial responsibility.
e) Increase the chances that patient D would’ve been informed of his LOC specific copays for his time in residential and php.
2. Over-reliance on instant verification may lead to further issues.
1. Having a staff member handling the patient accounts from start to finish could have helped in the following ways:
a) May have reduced the likelihood of patient B's premature d/c and at best, it could’ve completely prevented it.
b) May have increased the chances that patient E would’ve had their benefits discussed with them once they became coherent.
c) May have increased the chance that patient A would pay the remainder of his responsibility.
d) Regarding patient C’s initial claims adjudicated, a balance coming back could’ve helped the staff become aware of the erroneous verification. This in turn could’ve led to:
i. A live verification where the accumulations were sought.
ii. An increase in the possibility that the patient would be spoken to about what his potential cost share will actually look like.
iii. An increase in the chances that the patient would actually pay some or all of his financial responsibility.
e) Increase the chances that patient D would’ve been informed of his LOC specific copays for his time in residential and php.
2. Over-reliance on instant verification may lead to further issues.
Whether these five patients’ experiences reflect admissions’ usual financial discussions.
What the admission team is trained to use when determining what the initial estimation looks like.
Whether admissions generally attempts to collect more of the cost up front or not.
Whether the live verifications are completed with accumulations only when the instant verification shows that it is not met or whether this was a one time error.
What Cannot Be Surmised
What cannot be surmised from this 5 patient sample
What cannot be surmised from this 5 patient sample
1. Whether these five patients’ experiences reflect admissions’ usual financial discussions.
2. What the admission team is trained to use when determining what the initial estimation looks like.
3. Whether admissions generally attempts to collect more of the cost up front or not.
4. Whether the live verifications are completed with accumulations only when the instant verification shows that it is not met or whether this was a one time error.
This assessment identifies findings and recommends next steps; it does not demonstrate completed changes or achieved results. Reviewing additional accounts, developing procedures, training staff, or conducting patient outreach would be work beyond this assessment. The provider may carry that work out internally. Any further assistance requested from GAC would be scoped separately.
This assessment identifies findings and recommends next steps; it does not demonstrate completed changes or achieved results. Reviewing additional accounts, developing procedures, training staff, or conducting patient outreach would be work beyond this assessment. The provider may carry that work out internally. Any further assistance requested from GAC would be scoped separately.
This sample is illustrative and does not describe a client engagement or GAC result.
This sample is illustrative and does not describe a client engagement or GAC result.
What Your Records Show
The answer depends on your own accounts, workflows, and documentation. Follow the Number examines a defined sample so leadership can see what the record supports, what remains unknown, and where responsibility or follow-through may be breaking down.
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