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.