Medical Billing - To Both the Firm and the Outsider; Yes, it is a Nightmare!

To many outsiders, the medical billing world appears as a nice, neat little package. The truth is, the world of medical billing is ANYTHING but neat. Sometimes, many pieces have to be brought together before a bill can even be sent, depending on what you have done. Some procedures are simple. Then there are those that can turn into total NIGHTMARES. What follows is a true story to show you how complicated this can get. THE BELOW EXAMPLE WAS WRITTEN BY A GENTLEMAN NAMED Michael Russell:

A patient goes to the doctor for a routine checkup. During the checkout, it is discovered that the patient has some calcium buildup. The doctor explains to the patient all the things that this could possibly be including, most unlikely, TB. But just to make sure, the doctor gives the patient a TB test. Well, low and behold, the test comes back positive for TB. Now, it turns out that the patient works with a lot of immigrants who are probably in the country illegally and therefor there is a real possibility that the patient has TB, though it could be a false positive.

The next step is that the patient has to get a chest x-ray to determine if it is a false positive or if the patient really has TB. So, the patient is then sent from the doctor's office to an imaging center to get a chest x-ray. After the patient gets the chest x-ray, which turns out to be negative, the patient then has to go and get a blood test to determine if there are any blood and/or liver problems that would prevent the patient from getting a pill for the next nine months to keep the patient from actually getting TB. The patient is then sent to a lab to get a blood test.

So, let's review where we've been. We've been to the doctor for a checkup, covered by insurance, an imaging center for a chest x-ray, also covered by insurance and finally a lab for a blood test, which is also covered by insurance. Turns out that the x-ray is not covered by the patient's primary insurance but is covered by the secondary insurance.

Okay, ready for the billing procedure for this nightmare? The doctor submits a bill to the primary carrier. The lab submits a bill to the primary carrier. The imaging center also sends a bill to the primary carrier who rejects the claim. The imaging center notifies the patient who then has to submit the bill himself to the secondary carrier. The secondary carrier then sends requests to the doctor and the lab to see what other things were billed for this condition before they finally pay on the secondary claim.

If this had been handled by a medical billing agency, they would have sent all the bills at once on behalf of each place and the paying of the claims would have been handled automatically by the various carriers, including the secondary insurance.

So, if you think medical billing agencies don't perform a valuable service, this is one example where they save the patient and medical facilities a lot of grief. (Michael Russell)

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Medical Billing Costs to Consider

I was SO excited to earn my first medical billing account that I practically paid THEM to get started with me! I provided them with OUTSTANDING service as I hoped that they would become a valuable reference source for me over time. They eventually became my PRIMARY reference source due to my extra care and attention. What people fail to remember is that there are legitimate costs to a medical billing firm - even sole-practicing firms! You will have overall operation costs, but what I'm writing about today actually has to do with software fees or costs incurred due to non-payment of claims by the carriers. We can all agree that software fees are unavoidable. The trick is to PROTECT yourself when it comes to costs incurred by errors that are OUT of your control. For example; upon earning my first client, I took all of the applicable data necessary to set up this provider, to include provider numbers per insurance carrier. As a medical biller, I rely HEAVILY on the information given to me directly by the provider. How else would I learn their Medicare-specific Provider Identifier, for example? Well, after my very FIRST batch of claims submitted, I received a copy of an EOB from an insurance carrier that denied my claims due to an inaccurate provider ID. Naturally, after examining this with my client, I learned that they weren't even credentialed with that carrier! I sent 57 claims on this provider's behalf only to have all 57 deny payment. Because I did not have a "(RE)submit fee" in my contract, I did NOT get covered monitarily by that provider for the original submissions. This was a lesson that I learned the hard way. So, my tip for today is to include a (RE)submit fee in YOUR contract that covers your costs to the software provider and your labor at a PER claim rate. After my painful lesson, I now have this type of protection in my contracts with all of my providers.

Medical Billing Nightmares can Become a REALITY!

When I decided to begin a career in Medical Billing, I was so anxious and excited to just "get out there" and start doing it! I took a medical billing course, I acquired some marketing materials, I named my business, I ordered business cards, etc. As far as I was concerned, I was READY! After weeks of effort to get in front of doctors and practice owners, I FINALLY earned an appointment with a podiatrist - a very BUSY podiatrist! I was so excited. We held our first meeting. I asked the questions that I needed answers to, we got along brilliantly and I left with an appointment to return the following week to present my proposal. When I returned with my proposal, that doctor liked everything that he saw. He liked my service guarantee and my pricing, and most importantly, he liked ME! Then he asked the nightmare question, "Can you show me what you do - or what system you use to enter my medical claims?" Um... UH-OH. I was stumped! I HAD purchased a medical billing software, but NEVER saw it. I couldn't ever get someone LIVE to demonstrate the software, I couldn't afford to pay for a provider set up, which would allow me use of my software WITHOUT an actual doctor client because I hadn't generated any income yet! I knew it was there, and I SIMPLY assumed that I would "use it" once I had my first client. Boy was I wrong! I knew that I was NOT the only medical biller that this doctor was interviewing. None-the-less, one of the OTHER billers earned his business and I know why... I could not demonstrate my product. This was MY NIGHTMARE. I got all the way here, earned the trust that is needed, priced everything perfectly, and then I fell - I FELL HARD. I share this with you only to encourage you to align yourself with the BEST possible medical billing software available in todays market. Since that experience, I learned a lot! I bit the bullet and spent a lot of time interviewing and actually VIEWING demonstrations by various software providers. The one that I chose to buy has HELPED in my ability to earn clients. Now, when I provide a proposal for a doctor and we get to the point where they like my service offering, my pricing and ME - I OFFER to demonstrate my software and what I will be doing for them. My software provider will dial in remotely and run the demo, while we listen to that representative on speaker phone. Now, I sit back and enjoy the show along with the doctor. Because of this powerful relationship, I RARELY lose an opportunity. If I do, it is CERTAINLY NOT due to my lack of knowledge when it comes to my software any longer! I made sure of that. Do yourself a favor - CHOSE A SOFTWARE CAREFULLY!