WOW, what a rollercoaster ride this experience can be! I spent a total of 4 detailed meetings with a chiropractor. This gentleman had trouble with the turnover of his staff. He would hire someone and part of their job responsiblities was medical billing! Totally untrained and ill-prepared, these new employees would agree to undertake that crucial segment of the business and get into such a hole that they would end up quitting. Now, no one necessarily TOLD him that was the reason for the resignation. He just sensed this issue. So, I received a referral from someone that knows this particular chiropractor and I had an initial meeting where we exchanged basic data and all questions / concerns were addressed and I succeeded to receive an invitation to return with a price quote or proposal. I also set up a time to demo my software.
( I learned all of my understanding of the "order" of what to do to prepare for these meetings from a Business Start Up Manual created and offered by the members of The Medical Billing Foundation at http://www.MedicalBillingFoundation.com)
So, I returned and completed my demo with the assistance and expertise of my software representative. I proudly offered my proposal and THIS TIME, I was asked to leave the proposal for further review.
This, generally, is not a good sign. On occasion, depending upon the specialty and the size of the practice and if there is more than a single practitioner, than YES, of course I leave the proposal, fully understanding that it's not simply ONE person's decision. In THIS instance, however - it was just him. I have several chiropractic therapy clients, so experience and comfort was no issue. I know that I was competitive, but there was just "something missing". Some sort of missing element that he was unable to communicate and I was unable to unearth. BUMMER.
I scheduled a follow up appointment for one week out, which was fine. I returned to that appointment with a "blank" contract, so that if we needed to negotiate any points, we could do so fresh. I STILL pushed me off a bit by telling me that he has too much going on in his personal life with a divorce and he has to address his staffing issue, etc.
But, he assured me that we would work together and offered me a check for my set up costs as good will. I DID NOT deposit it, as I "felt" that something was still not quite right.
The ultimate ending of this story is that this Doctor is STILL months behind in billing, to the tune of $50,000 in claims to COLLECT (not just bill), he still has NO front staff person. He is absolutely burried in a billing nightmare and is still having personal issues. He is the same. The end all be all to this situation was that I EARNED and LOST an account in a matter of days! This was a nightmare to me. 1) I know I would totally help him. 2) it would have been a lucrative relationship for us both.
I suppose that the message here is to do your best to address ALL questions and concerns. Give 100% confidence and ALSO know that you will not "win" every account. Some will chose to stay in a difficult rutt for whatever reason.
Anyone else have similar stories???
Tuesday, July 31, 2007
Thursday, July 26, 2007
Medical Billing - Billing The Wrong Carrier
I located this article written by Mr. Russell.
As a professional Medical Biller, I know the scary side of innocent "mistakes" gone terribly wrong...
The best protection? Document, document, document each conversation with whom at what number and extension at what time and at what location in what department and by what employee id number and so on! The more? The Better!
Yes, seriously!
Anyway... this is interesting...
For this article and more, please visit http://www.ezinearticles.com
In a previous installment of medical billing goofs, we discussed what happens when you bill the wrong item to a carrier and how you can be charged with fraud, but what happens when you send a bill to the wrong carrier. What follows is a genuine story. It's kind of funny when you read it, but the truth is, it's far from funny. This is some serious stuff.
A medical billing company, we'll call them XYZ company, was sending out a claim for a patient, we'll call him John Smith, to Medicare Region A, which is in the New York area of the United States. Now in actuality, the name of the patient was a common name so there could have very well been many people with that name.
Anyway, the bill makes its way to Medicare Region A and the response from Region A is that they are not going to pay the claim because the patient that the company was billing was dead. Well, to make a long story short, the medical billing company gets on a conference call with Medicare Region A and the patient. On the one end, the patient is screaming at the carrier, "How can I be dead? I'm right here". The carrier simply responds that according to their records, the patient is dead.
Well, this back and forth goes on for quite a while with quite a few phone calls. Finally, Medicare Region A decides that they're going to go over the patient's records with the patient and the medical billing agency. So they begin the questions starting with name, address, etc. Well, when the patient gives the carrier his street address and state, the carrier responds with the following. "Sir, Texas is not in our region". Well, it turns out that the patient had the same street address as another patient in New York. Everything was exactly the same except for the state, which nobody bothered to check. So what happened was that the patient had his claim sent to Medicare Region A when it should have gone to Medicare Region C.
Everybody had a real good laugh about this, but the problem still wasn't solved. Now the claim had to be forwarded to Medicare Region C. The problem was that the medical billing agency was not licensed to bill Medicare Region C. They only had a package to bill Medicare Region A. So now they had to see if they could get Medicare Region A to forward the claim to Medicare Region C. Well, they could, but there was a charge for this. Well, the medical billing agency said no way. So what did they do?
They got a hold of another medical billing agency that did bill Medicare Region C and arranged to do a swap. They'd bill one of their patients for them, thus incurring the cost, if they'd bill Medicare Region C for them. The company agreed and sent the claim. The problem was finally solved.
You can't make this stuff up.
As a professional Medical Biller, I know the scary side of innocent "mistakes" gone terribly wrong...
The best protection? Document, document, document each conversation with whom at what number and extension at what time and at what location in what department and by what employee id number and so on! The more? The Better!
Yes, seriously!
Anyway... this is interesting...
For this article and more, please visit http://www.ezinearticles.com
In a previous installment of medical billing goofs, we discussed what happens when you bill the wrong item to a carrier and how you can be charged with fraud, but what happens when you send a bill to the wrong carrier. What follows is a genuine story. It's kind of funny when you read it, but the truth is, it's far from funny. This is some serious stuff.
A medical billing company, we'll call them XYZ company, was sending out a claim for a patient, we'll call him John Smith, to Medicare Region A, which is in the New York area of the United States. Now in actuality, the name of the patient was a common name so there could have very well been many people with that name.
Anyway, the bill makes its way to Medicare Region A and the response from Region A is that they are not going to pay the claim because the patient that the company was billing was dead. Well, to make a long story short, the medical billing company gets on a conference call with Medicare Region A and the patient. On the one end, the patient is screaming at the carrier, "How can I be dead? I'm right here". The carrier simply responds that according to their records, the patient is dead.
Well, this back and forth goes on for quite a while with quite a few phone calls. Finally, Medicare Region A decides that they're going to go over the patient's records with the patient and the medical billing agency. So they begin the questions starting with name, address, etc. Well, when the patient gives the carrier his street address and state, the carrier responds with the following. "Sir, Texas is not in our region". Well, it turns out that the patient had the same street address as another patient in New York. Everything was exactly the same except for the state, which nobody bothered to check. So what happened was that the patient had his claim sent to Medicare Region A when it should have gone to Medicare Region C.
Everybody had a real good laugh about this, but the problem still wasn't solved. Now the claim had to be forwarded to Medicare Region C. The problem was that the medical billing agency was not licensed to bill Medicare Region C. They only had a package to bill Medicare Region A. So now they had to see if they could get Medicare Region A to forward the claim to Medicare Region C. Well, they could, but there was a charge for this. Well, the medical billing agency said no way. So what did they do?
They got a hold of another medical billing agency that did bill Medicare Region C and arranged to do a swap. They'd bill one of their patients for them, thus incurring the cost, if they'd bill Medicare Region C for them. The company agreed and sent the claim. The problem was finally solved.
You can't make this stuff up.
Friday, July 13, 2007
The Legal Risks of Boutique Medicine - and the Nightmares That Come With it.
Here is an interesting article published by an attorney concerning the trend in Medical Billing for Concierge and Boutique Medical Practices and the fact that the establishment of such practitioners and their daily practices appear to remain ahead of the laws to date. As a professional Medical Biller, the trend can prove a challenge - more and more practitioners are "joining" Boutique practices to avoid the headaches associated with running an individual practices and the nightmare billing that comes with it!
A small but growing trend in medicine is the establishment of "concierge" or "boutique" medical practices. For a fee, ranging anywhere from $900 to $20,000 per patient per year, a physician agrees to provide a range of primary care medical services to a limited number of patients.
The range of services typically focuses on wellness or preventative medicine, but can span the entire scope of a primary care practice. Often included in the services provided are amenities and preferences that are not usually associated with physician practices, including 24-hour/seven-day-a-week access to the physician, same-day or next-day-preferred appointments, private reception areas, and even such luxuries as free hotel rooms for out-of-town patients, heated towel racks, and monogrammed bathrobes. Membership is usually limited to 300 to 600 patients. Some practices cater exclusively to these patients, refusing to take any Medicare or private insurance. Others continue to provide these services and apply the membership fee only to those services that are not covered by Medicare or private insurance.
There are several high-profile examples of these types of practices throughout the country. In Florida, a company called MDVIP has been in the forefront of this movement and offers ambitious plans to recruit 1,000 physicians nationwide. In Seattle, the former team physician for the Seattle Supersonics has converted his practice into this type of arrangement. Two well-known internists in the Boston area converted their practice into a boutique arrangement. Even in Arizona, such practices have already been established and more are on the way.
Physicians who have begun these practices extol their virtues in glowing terms. They cite the financial and psychological benefits of being free from dealing with the legal requirements and billing nightmares associated with Medicare and insurance companies. Because the number of patients permitted to become members of a boutique practice is limited, physicians are able to spend much more time with each patient, which these doctors are certain increases the quality of care provided.
On the other hand, many medical ethicists, consumer advocates, and government officials express concern over the creation of a two-class system of medicine, with more services and higher quality available to those who can afford the often substantial membership fees required by these practices. They ask what will happen to the Medicare system if more doctors elect to opt out and attempt to serve an all-cash patient population only.
These practices have not slipped under the radar screen of government officials, as numerous investigations and other efforts to stop this movement have begun. The most visible action was a letter sent in March of this year to the Inspector General for the Department of Health and Human Services by five members of Congress, including Representative Henry Waxman from California and Representative Pete Stark, the author of the Stark self-referral law. In their letter, the Congressmen raise several concerns that the boutique practices are violating federal laws, and they asked the Inspector General to take "rapid action" against these practices. Last year, Senator Bill Nelson of Florida introduced a bill in Congress to prohibit physicians from charging additional fees to Medicare patients. In addition, various state agencies have begun their own investigations. Departments of Insurance in the states of Massachusetts and Florida are reviewing the practice.
The legal risks with these practices can be briefly summarized. Most of these risks arise when a practice continues to seek reimbursement from Medicare and private health insurance companies for covered services in addition to providing these additional "boutique" services for a separate fee.
Violation of Medicare regulations. Medicare regulations prohibit charging Medicare beneficiaries for services covered by Medicare. Some argue that the services offered for the additional membership fee overlap with services that are covered by Medicare. To the extent that there is such overlap, charging for such services would constitute a clear violation. However, there is significant dispute over whether any such services would be reimbursable under Medicare.
Violation of the False Claims Act. In their letter, the five Congressmen alleged that the annual membership fee should be considered part of the charges for basic office visits, which charges are often reimbursed by Medicare or health insurance plans. As the letter itself explains:
An MDVIP patient, for example, might pay $1,500 per year in order to see his or her doctor five times for covered services, with each visit costing an additional $100 (billed to Medicare). Looking back, the true charge for each visit, including the value of the annual fee, was really $400. By failing to put the true charge on its claim to Medicare, a physician could be violating the False Claims Act. Of course, if the membership fee is for additional services provided by the doctor, then it may not be accurate to allocate that fee to office visits and other items normally covered by Medicare.
Violations of provider agreements with private insurance companies. Most private insurance company provider agreements prohibit balance billing of patients in a manner that could prevent charging any amounts to enrollees of those health plans, even for non-covered services. If these arrangements were found to violate Medicare regulations, they are likely to also violate private health insurance provider contracts in the same manner.
Violation of state insurance laws. To the extent that these practices require annual prepaid membership fees, they could be viewed as offering insurance without a license. If the physician is taking the risk of providing these services for a cost greater than the fee paid to him, insurance statutes define the offering of insurance broadly enough in many respects to encompass such an arrangement.
Violation of the anti-kickback statute or other laws prohibiting payments to induce patient referrals. To the extent that the practices offer amenities such as heated towel racks, free hotel rooms, special bathrobes, and the like, these luxuries could be viewed as improper inducements under the federal anti-kickback statute or provisions of the Health Insurance Portability And Accountability Act that prohibit such inducements. Of course, since these amenities are offered only upon payment of a fee, they could be nothing more than an exchange of fair value in return for what was paid.
Abandonment of existing patients. Often, a physician who attempts to transition an existing practice to a boutique practice which limits the number of patients will have to terminate his relationship with many existing patients. If that is not done correctly, the physician could expose himself to liability for abandonment.
In many situations, trends in the health care industry have run far ahead of the applicable law, requiring the law to be changed to catch up with what quickly becomes common industry practice. For example, the explosion of physician networks or IPAs required clarifications of the antitrust statutes in order to permit them. On the other hand, sometimes common practices are shut down once the law catches up to them, such as the widespread practice of physicians selling prescription drugs over the Internet. Clearly, boutique medical practices are ahead of the law at this point. Whether the law adapts to permit or prohibit them remains to be seen.
A small but growing trend in medicine is the establishment of "concierge" or "boutique" medical practices. For a fee, ranging anywhere from $900 to $20,000 per patient per year, a physician agrees to provide a range of primary care medical services to a limited number of patients.
The range of services typically focuses on wellness or preventative medicine, but can span the entire scope of a primary care practice. Often included in the services provided are amenities and preferences that are not usually associated with physician practices, including 24-hour/seven-day-a-week access to the physician, same-day or next-day-preferred appointments, private reception areas, and even such luxuries as free hotel rooms for out-of-town patients, heated towel racks, and monogrammed bathrobes. Membership is usually limited to 300 to 600 patients. Some practices cater exclusively to these patients, refusing to take any Medicare or private insurance. Others continue to provide these services and apply the membership fee only to those services that are not covered by Medicare or private insurance.
There are several high-profile examples of these types of practices throughout the country. In Florida, a company called MDVIP has been in the forefront of this movement and offers ambitious plans to recruit 1,000 physicians nationwide. In Seattle, the former team physician for the Seattle Supersonics has converted his practice into this type of arrangement. Two well-known internists in the Boston area converted their practice into a boutique arrangement. Even in Arizona, such practices have already been established and more are on the way.
Physicians who have begun these practices extol their virtues in glowing terms. They cite the financial and psychological benefits of being free from dealing with the legal requirements and billing nightmares associated with Medicare and insurance companies. Because the number of patients permitted to become members of a boutique practice is limited, physicians are able to spend much more time with each patient, which these doctors are certain increases the quality of care provided.
On the other hand, many medical ethicists, consumer advocates, and government officials express concern over the creation of a two-class system of medicine, with more services and higher quality available to those who can afford the often substantial membership fees required by these practices. They ask what will happen to the Medicare system if more doctors elect to opt out and attempt to serve an all-cash patient population only.
These practices have not slipped under the radar screen of government officials, as numerous investigations and other efforts to stop this movement have begun. The most visible action was a letter sent in March of this year to the Inspector General for the Department of Health and Human Services by five members of Congress, including Representative Henry Waxman from California and Representative Pete Stark, the author of the Stark self-referral law. In their letter, the Congressmen raise several concerns that the boutique practices are violating federal laws, and they asked the Inspector General to take "rapid action" against these practices. Last year, Senator Bill Nelson of Florida introduced a bill in Congress to prohibit physicians from charging additional fees to Medicare patients. In addition, various state agencies have begun their own investigations. Departments of Insurance in the states of Massachusetts and Florida are reviewing the practice.
The legal risks with these practices can be briefly summarized. Most of these risks arise when a practice continues to seek reimbursement from Medicare and private health insurance companies for covered services in addition to providing these additional "boutique" services for a separate fee.
Violation of Medicare regulations. Medicare regulations prohibit charging Medicare beneficiaries for services covered by Medicare. Some argue that the services offered for the additional membership fee overlap with services that are covered by Medicare. To the extent that there is such overlap, charging for such services would constitute a clear violation. However, there is significant dispute over whether any such services would be reimbursable under Medicare.
Violation of the False Claims Act. In their letter, the five Congressmen alleged that the annual membership fee should be considered part of the charges for basic office visits, which charges are often reimbursed by Medicare or health insurance plans. As the letter itself explains:
An MDVIP patient, for example, might pay $1,500 per year in order to see his or her doctor five times for covered services, with each visit costing an additional $100 (billed to Medicare). Looking back, the true charge for each visit, including the value of the annual fee, was really $400. By failing to put the true charge on its claim to Medicare, a physician could be violating the False Claims Act. Of course, if the membership fee is for additional services provided by the doctor, then it may not be accurate to allocate that fee to office visits and other items normally covered by Medicare.
Violations of provider agreements with private insurance companies. Most private insurance company provider agreements prohibit balance billing of patients in a manner that could prevent charging any amounts to enrollees of those health plans, even for non-covered services. If these arrangements were found to violate Medicare regulations, they are likely to also violate private health insurance provider contracts in the same manner.
Violation of state insurance laws. To the extent that these practices require annual prepaid membership fees, they could be viewed as offering insurance without a license. If the physician is taking the risk of providing these services for a cost greater than the fee paid to him, insurance statutes define the offering of insurance broadly enough in many respects to encompass such an arrangement.
Violation of the anti-kickback statute or other laws prohibiting payments to induce patient referrals. To the extent that the practices offer amenities such as heated towel racks, free hotel rooms, special bathrobes, and the like, these luxuries could be viewed as improper inducements under the federal anti-kickback statute or provisions of the Health Insurance Portability And Accountability Act that prohibit such inducements. Of course, since these amenities are offered only upon payment of a fee, they could be nothing more than an exchange of fair value in return for what was paid.
Abandonment of existing patients. Often, a physician who attempts to transition an existing practice to a boutique practice which limits the number of patients will have to terminate his relationship with many existing patients. If that is not done correctly, the physician could expose himself to liability for abandonment.
In many situations, trends in the health care industry have run far ahead of the applicable law, requiring the law to be changed to catch up with what quickly becomes common industry practice. For example, the explosion of physician networks or IPAs required clarifications of the antitrust statutes in order to permit them. On the other hand, sometimes common practices are shut down once the law catches up to them, such as the widespread practice of physicians selling prescription drugs over the Internet. Clearly, boutique medical practices are ahead of the law at this point. Whether the law adapts to permit or prohibit them remains to be seen.
Monday, July 9, 2007
Medical Billing - The 13 Core Steps to Avoid Nightmares
I found this step-by-step guide published at www.MedicalBillingandCoding.net
I thought it useful to refer to as a means of staying on track to avoid falling away from general duties of a professional, full time medical biller.
See if you agree;
13 Steps Work Flow Chart:
1. Enter your patient information, adding new insurance carriers to your database as you go.
2. Enter the referral source or referring physician as well as any other information you've agreed to track for your clients.
3. Enter CPT and ICD-9 codes from the superbills and day sheets. Your software will automatically fill in the amounts charged for each procedure. Enter each charge on a separate line.
4. Transmit electronic claims directly to insurance carriers or to the clearinghouse.
5. Receive the audit report, review and correct errors on it.
6. Forward clean claims and resubmit rejected claims.
7. Print any paper claims.
8. Separate claims into your copy and the insurer's, fold and insert in envelopes.
9. Weigh envelopes that contain more than five claims to make sure you have sufficient postage.
10. Post payments to each patient's account. Most software programs include features that show which charges have been paid, how much is left on each charge and which charges are still unpaid.
11. Print aging reports so you can review each patient's account to determine which ones haven't been paid in a timely manner. Most software packages will do this for you.
12. Call insurance carriers to check on the status of delinquent claims. Most of your follow-up calls will be for paper claims.
13. Put your feet up and relax. You've earned a breather
I thought it useful to refer to as a means of staying on track to avoid falling away from general duties of a professional, full time medical biller.
See if you agree;
13 Steps Work Flow Chart:
1. Enter your patient information, adding new insurance carriers to your database as you go.
2. Enter the referral source or referring physician as well as any other information you've agreed to track for your clients.
3. Enter CPT and ICD-9 codes from the superbills and day sheets. Your software will automatically fill in the amounts charged for each procedure. Enter each charge on a separate line.
4. Transmit electronic claims directly to insurance carriers or to the clearinghouse.
5. Receive the audit report, review and correct errors on it.
6. Forward clean claims and resubmit rejected claims.
7. Print any paper claims.
8. Separate claims into your copy and the insurer's, fold and insert in envelopes.
9. Weigh envelopes that contain more than five claims to make sure you have sufficient postage.
10. Post payments to each patient's account. Most software programs include features that show which charges have been paid, how much is left on each charge and which charges are still unpaid.
11. Print aging reports so you can review each patient's account to determine which ones haven't been paid in a timely manner. Most software packages will do this for you.
12. Call insurance carriers to check on the status of delinquent claims. Most of your follow-up calls will be for paper claims.
13. Put your feet up and relax. You've earned a breather
Wednesday, July 4, 2007
Medical Billing Nightmares - Common Mistakes in Medical Billing
Common Mistakes in Medical Billing
Errors in the billing process can significantly reduce the profitability of a medical practice and should be avoided. By having a clear understanding of the entire coding and billing process and developing protocols for practice management, the medical office can run smoothly, efficiently and ensure maximum profitability.
A well-run and profitable medical practice always has a written procedures manual for all phases of operation. Most importantly, procedures in the reimbursement process: billing and coding, insurance issues and patient accounts should be kept in easy reach. Clear guidelines on the processes to manage accurate entry of all services provided and generation of correct insurance claims and patient bills lets all staff members know the accepted protocols and provides an easy to access reference when questions arise.
Errors in the reimbursement process fall into two categories. The first kind of error is technical: errors in generating and submitting claims, and then in processing payments correctly. Technical errors include missing or inaccurate data on claim forms. The second kind of error is in customer service: mistakes in managing patients accounts and treating patients in a way that is disturbing or disrespectful. Both of these mistakes can have grave consequences in the profitability and success of a medical practice.
In addition to clearly spelling out the steps of all phases of the billing cycle, office procedures manuals should address common mistakes in the reimbursement process. Some of the most common problems are outlined below.
1.) Technical errors
Mistakes in the technical aspects billing process cost money for a practice because claims are needlessly denied or delayed. These included claims and coding errors and insurance errors. Correcting the problems requires time spent researching the problem, making corrections, and generating a duplicate claim form. Unfortunately, a problem in many medical offices is follow up on unpaid claims. Many times, poor follow up leads to unnecessary write-offs and lost revenue. Careful attention to procedures can rectify most of these kinds of errors.
2.) Claims and Coding errors
Illegible claims
Misalignment of printed claims
Coding errors
Unbundling
Upcoding
Services provided without a medical necessary
Incorrect/outdated diagnosis or procedure codes
Insurance errors
3.) Failure to obtain pre-authorization of referrals
Submission of claims to wrong insurance company or outdated address
Failure to obtain insurance information for responsible party when a dependent or spouse is being treated
Calculating co-insurance based on incorrect fee schedule
Miscalculation of deductible, copays or so-insurance
Other common mistakes in medical office reimbursement involve billing and financial policies. It’s a well know fact that the longer a bill goes unpaid, the less chance of recovering payments. That means that timely and efficient handling of accounts receivable is critical. Some common errors in this area are listed here.
4.) Billing errors
Lack of consistent billing cycle
Statements patients can’t understand
Credits not posted to patient accounts
Overcharging
Duplicate billing
Charges for services not provided
Billing for services that are not medically necessary
Exceeding time limit for filing claims
Incorrect or inappropriate Finance charges
Poor Financial Policies
5.) Rebilling charged-off balances
Denial of necessary care for financial reasons
Intimidating or threatening collection efforts
Non-compliance with insurance contracts
Verbal payment agreements
Inconsistent collection practices
Reluctance or refusal to explain billing policies and patient statements
Errors occur. It's inevitable. BUT, catch them! As a medical biller, it is your job! Pointing out errors, owning up to errors, and FIXING the errors will help you KEEP clients. The oposite practices will cause you to loose clients!
For more information about medical billing nightmares, visit www.MedicalBillingFoundation.com
Errors in the billing process can significantly reduce the profitability of a medical practice and should be avoided. By having a clear understanding of the entire coding and billing process and developing protocols for practice management, the medical office can run smoothly, efficiently and ensure maximum profitability.
A well-run and profitable medical practice always has a written procedures manual for all phases of operation. Most importantly, procedures in the reimbursement process: billing and coding, insurance issues and patient accounts should be kept in easy reach. Clear guidelines on the processes to manage accurate entry of all services provided and generation of correct insurance claims and patient bills lets all staff members know the accepted protocols and provides an easy to access reference when questions arise.
Errors in the reimbursement process fall into two categories. The first kind of error is technical: errors in generating and submitting claims, and then in processing payments correctly. Technical errors include missing or inaccurate data on claim forms. The second kind of error is in customer service: mistakes in managing patients accounts and treating patients in a way that is disturbing or disrespectful. Both of these mistakes can have grave consequences in the profitability and success of a medical practice.
In addition to clearly spelling out the steps of all phases of the billing cycle, office procedures manuals should address common mistakes in the reimbursement process. Some of the most common problems are outlined below.
1.) Technical errors
Mistakes in the technical aspects billing process cost money for a practice because claims are needlessly denied or delayed. These included claims and coding errors and insurance errors. Correcting the problems requires time spent researching the problem, making corrections, and generating a duplicate claim form. Unfortunately, a problem in many medical offices is follow up on unpaid claims. Many times, poor follow up leads to unnecessary write-offs and lost revenue. Careful attention to procedures can rectify most of these kinds of errors.
2.) Claims and Coding errors
Illegible claims
Misalignment of printed claims
Coding errors
Unbundling
Upcoding
Services provided without a medical necessary
Incorrect/outdated diagnosis or procedure codes
Insurance errors
3.) Failure to obtain pre-authorization of referrals
Submission of claims to wrong insurance company or outdated address
Failure to obtain insurance information for responsible party when a dependent or spouse is being treated
Calculating co-insurance based on incorrect fee schedule
Miscalculation of deductible, copays or so-insurance
Other common mistakes in medical office reimbursement involve billing and financial policies. It’s a well know fact that the longer a bill goes unpaid, the less chance of recovering payments. That means that timely and efficient handling of accounts receivable is critical. Some common errors in this area are listed here.
4.) Billing errors
Lack of consistent billing cycle
Statements patients can’t understand
Credits not posted to patient accounts
Overcharging
Duplicate billing
Charges for services not provided
Billing for services that are not medically necessary
Exceeding time limit for filing claims
Incorrect or inappropriate Finance charges
Poor Financial Policies
5.) Rebilling charged-off balances
Denial of necessary care for financial reasons
Intimidating or threatening collection efforts
Non-compliance with insurance contracts
Verbal payment agreements
Inconsistent collection practices
Reluctance or refusal to explain billing policies and patient statements
Errors occur. It's inevitable. BUT, catch them! As a medical biller, it is your job! Pointing out errors, owning up to errors, and FIXING the errors will help you KEEP clients. The oposite practices will cause you to loose clients!
For more information about medical billing nightmares, visit www.MedicalBillingFoundation.com
Tuesday, July 3, 2007
Medical Billing Nightmares - This Time to The Consumer / Insurance Policy Owners
I found an article today that does a great job illustrating Medical Billing Nightmares to the CONSUMER by www.Credit.com. It does touch on processes as a Medical Biller and offers great resources at the bottom of the article. I would like to add 2 resources as a Medical Biller; www.MedicalBillingCourse.com AND www.MedicalBillingFoundation.com - VISIT THESE. You will be set up for your business by these TWO sites alone.
Medical Bill Nightmares
by Emily Davidson for Credit.com
It could happen to anyone at anytime. A trip to the emergency room or bad news from your doctor could result in thousands of dollars in medical bills. Even with medical insurance, you may end up with catastrophic debt as a result of your illness. To make matters worse, many health care providers have unfair billing practices that only add to the financial issues faced by patients. Except for a few billionaires, every American is just one major illness away from bankruptcy. In this article we outline this issue and show you what you can do to avoid medical bill nightmares.
The facts
Medical debt issues impact us all, whether you have insurance or not. Here are some startling statistics:
Uninsured patients – Over 45 million Americans (15% of the population) don’t have health insurance. Nearly half of people without medical insurance currently have outstanding medical debts, averaging $9,000 per person.
Insured patients – Over 60% of families who report having medical debt problems are covered by medical insurance. In fact, 75% of people who filed for bankruptcy because of medical debts had health insurance.
The issues
A recent report from the National Consumer Law Center highlighted the growing problem of abusive medical debt collection practices. According to their report, hospitals use the following tactics:
Not offering charity care – Hospital are often officially registered as non-profits on the basis that they provide free or discounted health services to qualified patients. However, it has been shown that more than 70% of patients with medical debts are never offered financial assistance from their providers. In fact, uninsured and poor patients are routinely charged much higher prices for their treatment than others.
Suing patients and their spouses – Health care providers can send medical debts to collections, file judgments, garnish wages, obtain home liens, and even take patients to court over medical bills that they cannot afford to pay. In many cases, the spouses of patients are pursued for payment even if they don’t live in a common law state.
Offering expensive credit to patients – If you have medical bills you are unable to pay, health care providers may offer you expensive credit cards or loans as a solution. For example, Kaiser offers a credit card with a 9.9% introductory rate that quickly increases to 24.24%. Some of these accounts are so expensive that your debt will actually increase as you pay each month.
Using collections and credit to coerce patients – Debt issues can lead to serious credit score damage. When health care providers sell debts to collections, file judgments, and obtain liens, they are damaging the patient’s credit profile. According to the Federal Reserve, over 50% of collection records and 20% of lawsuits that appear on credit reports are related to medical debts.
Denying future care to debtors– Some health care providers have strict policies in place that deny health care to patients who owe money for previous treatments. In rural areas, there may be few health care alternatives available for people who are ill and unable to pay their debts.
All together, these abusive debt practices can lead consumers with health problems to destroy their credit, lose their homes, or file for bankruptcy. Without an understanding of their rights, a secure financial standing, and a willingness to negotiate, many patients are stuck facing a financial crisis at the same time as a health crisis.
The options
If you find yourself unable to repay medical bills or in the hospital without insurance, there are a few things you can do to avoid being stuck with an unmanageable amount of debt.
Know your options – Evaluate all the insurance, Medicaid, and charity options available to you. The time it takes to investigate possible alternatives to high medical bills is well worth it. Don’t be afraid to ask the medical billing office questions about your options. Keep asking if there is something you don’t understand about your insurance or financing choices.
Review your bills closely – It’s is very common to find double billings and errors on health care invoices. Take the time to closely review each of your bills and challenge any costs that you feel are incorrect. When you are challenging bills, however, be sure that the medical office is not selling your debts to collections while they are in dispute.
Pay with credit card– Use your own low APR credit card to pay for medical bills instead of opening a new account through the hospital. If possible, choose a credit card with a long 0% introductory rate and a low APR after that period expires.
Avoid financial traps – Pay your most important bills (such as your mortgage) first, before you pay medical bills. Never use a home equity loan to pay expensive medical bills. This type of loan can put your home at risk if you are unable to pay.
The solutions
Increased attention has recently been paid to the issue of unfair medical billing practices. With recent reports by The Access Fund, Harvard University, and the NCLC, the dramatic issues that patients face are coming to light. The following regulations are recommended in order to improve patient’s rights and control abusive medical billings:
Regulate charity care programs – Health care providers should have clear standards to follow in regards to providing free or reduced care to patients. Patients should be given a full disclosure of their financing and assistance options.
Set clear income discount policies – Sliding scale billing should be instituted to ensure that the poorest patients aren’t paying the most for their health care. The same discounts that insurance companies receive on medical bills should be applied to consumers.
Establish reasonable payment programs – Medical offices could actually increase their billing returns by establishing longer repayment periods with monthly minimums tied to the patient’s income. Just as student loans are set with low interest rates and low monthly payments, medical debt repayment should be affordable.
Restrict the sale of debts to collections – Medical debts should not be sold to collection agencies until payment negotiations have been completed and a set amount of time has passed. Also, the use of wage garnishment, property liens, and judgments for medical bill collection should be restricted.
Cap medical prices for low income patients – Health care providers should not collect more than the actual costs of services from patients who are low-income or uninsured. Currently, these patients often pay inflated “sticker prices” for their medical care.
Protect spouses from medical debts – Restrict health care providers from using common law doctrines to collect medical debts from spouses of patients, especially when these spouses are elderly or low-income.
Some of these reforms are already in place in certain areas. For example, California, Massachusetts and Texas require health care providers to account for their charity care spending. Connecticut currently has laws in place that prohibit charity care hospitals from suing a patient for debts until it is determined that the debtor is not eligible for free or reduced costs services.
The resources
If you are interested in learning more about this issue, you can visit the following consumer agencies and organizations that are campaigning against abusive medical billing practices:
National Consumer Law Coalition – www.consumerlaw.org
Access Project – www.accessproject.org
Bill Advocates – www.billadvocates.com
Consumers Union – www.consumersunion.org
Hospital Debt Justice – www.hospitaldebtjustice.org
Medical Bill Nightmares
by Emily Davidson for Credit.com
It could happen to anyone at anytime. A trip to the emergency room or bad news from your doctor could result in thousands of dollars in medical bills. Even with medical insurance, you may end up with catastrophic debt as a result of your illness. To make matters worse, many health care providers have unfair billing practices that only add to the financial issues faced by patients. Except for a few billionaires, every American is just one major illness away from bankruptcy. In this article we outline this issue and show you what you can do to avoid medical bill nightmares.
The facts
Medical debt issues impact us all, whether you have insurance or not. Here are some startling statistics:
Uninsured patients – Over 45 million Americans (15% of the population) don’t have health insurance. Nearly half of people without medical insurance currently have outstanding medical debts, averaging $9,000 per person.
Insured patients – Over 60% of families who report having medical debt problems are covered by medical insurance. In fact, 75% of people who filed for bankruptcy because of medical debts had health insurance.
The issues
A recent report from the National Consumer Law Center highlighted the growing problem of abusive medical debt collection practices. According to their report, hospitals use the following tactics:
Not offering charity care – Hospital are often officially registered as non-profits on the basis that they provide free or discounted health services to qualified patients. However, it has been shown that more than 70% of patients with medical debts are never offered financial assistance from their providers. In fact, uninsured and poor patients are routinely charged much higher prices for their treatment than others.
Suing patients and their spouses – Health care providers can send medical debts to collections, file judgments, garnish wages, obtain home liens, and even take patients to court over medical bills that they cannot afford to pay. In many cases, the spouses of patients are pursued for payment even if they don’t live in a common law state.
Offering expensive credit to patients – If you have medical bills you are unable to pay, health care providers may offer you expensive credit cards or loans as a solution. For example, Kaiser offers a credit card with a 9.9% introductory rate that quickly increases to 24.24%. Some of these accounts are so expensive that your debt will actually increase as you pay each month.
Using collections and credit to coerce patients – Debt issues can lead to serious credit score damage. When health care providers sell debts to collections, file judgments, and obtain liens, they are damaging the patient’s credit profile. According to the Federal Reserve, over 50% of collection records and 20% of lawsuits that appear on credit reports are related to medical debts.
Denying future care to debtors– Some health care providers have strict policies in place that deny health care to patients who owe money for previous treatments. In rural areas, there may be few health care alternatives available for people who are ill and unable to pay their debts.
All together, these abusive debt practices can lead consumers with health problems to destroy their credit, lose their homes, or file for bankruptcy. Without an understanding of their rights, a secure financial standing, and a willingness to negotiate, many patients are stuck facing a financial crisis at the same time as a health crisis.
The options
If you find yourself unable to repay medical bills or in the hospital without insurance, there are a few things you can do to avoid being stuck with an unmanageable amount of debt.
Know your options – Evaluate all the insurance, Medicaid, and charity options available to you. The time it takes to investigate possible alternatives to high medical bills is well worth it. Don’t be afraid to ask the medical billing office questions about your options. Keep asking if there is something you don’t understand about your insurance or financing choices.
Review your bills closely – It’s is very common to find double billings and errors on health care invoices. Take the time to closely review each of your bills and challenge any costs that you feel are incorrect. When you are challenging bills, however, be sure that the medical office is not selling your debts to collections while they are in dispute.
Pay with credit card– Use your own low APR credit card to pay for medical bills instead of opening a new account through the hospital. If possible, choose a credit card with a long 0% introductory rate and a low APR after that period expires.
Avoid financial traps – Pay your most important bills (such as your mortgage) first, before you pay medical bills. Never use a home equity loan to pay expensive medical bills. This type of loan can put your home at risk if you are unable to pay.
The solutions
Increased attention has recently been paid to the issue of unfair medical billing practices. With recent reports by The Access Fund, Harvard University, and the NCLC, the dramatic issues that patients face are coming to light. The following regulations are recommended in order to improve patient’s rights and control abusive medical billings:
Regulate charity care programs – Health care providers should have clear standards to follow in regards to providing free or reduced care to patients. Patients should be given a full disclosure of their financing and assistance options.
Set clear income discount policies – Sliding scale billing should be instituted to ensure that the poorest patients aren’t paying the most for their health care. The same discounts that insurance companies receive on medical bills should be applied to consumers.
Establish reasonable payment programs – Medical offices could actually increase their billing returns by establishing longer repayment periods with monthly minimums tied to the patient’s income. Just as student loans are set with low interest rates and low monthly payments, medical debt repayment should be affordable.
Restrict the sale of debts to collections – Medical debts should not be sold to collection agencies until payment negotiations have been completed and a set amount of time has passed. Also, the use of wage garnishment, property liens, and judgments for medical bill collection should be restricted.
Cap medical prices for low income patients – Health care providers should not collect more than the actual costs of services from patients who are low-income or uninsured. Currently, these patients often pay inflated “sticker prices” for their medical care.
Protect spouses from medical debts – Restrict health care providers from using common law doctrines to collect medical debts from spouses of patients, especially when these spouses are elderly or low-income.
Some of these reforms are already in place in certain areas. For example, California, Massachusetts and Texas require health care providers to account for their charity care spending. Connecticut currently has laws in place that prohibit charity care hospitals from suing a patient for debts until it is determined that the debtor is not eligible for free or reduced costs services.
The resources
If you are interested in learning more about this issue, you can visit the following consumer agencies and organizations that are campaigning against abusive medical billing practices:
National Consumer Law Coalition – www.consumerlaw.org
Access Project – www.accessproject.org
Bill Advocates – www.billadvocates.com
Consumers Union – www.consumersunion.org
Hospital Debt Justice – www.hospitaldebtjustice.org
Monday, July 2, 2007
Medical Billing - Improving Cash Flow: Start with Denials & Missing Information…
Often, a practice CAN BE "on the fence" in their decision to hire you as their Medical Billing Firm. If that is the case, ask them to "test" your services by giving you the "junk" or denied claims. I own and operate a successful Medical Billing company and YES; I too occasionally have to "prove" my services. It's not often, but it does come up. When their hesitation is clear, I offer to take on their most difficult claims and/or insurance carrier fact-finding work, which takes their staff member too much time. Now, of course I ask for a per-hour fee and a higher percentage for working these denied or old claims. They are a lot more work than the fresh ones and often need to go through an appeals process. This process has earned me SEVERAL accounts. After reaping the rewards of my diligent work on these old claims (a.k.a. income), they hire me immediately and WITHOUT hesitation. For more information and true guidance as a medical biller, visit www.MedicalBillingFoundation.com. This is the ONLY institution available that offers this level of counseling, instruction, ideas and support concerning these types of scenarios that you, as a biller, can undertake to ultimately earn ALL business opportunities that are offered up to you. Try to NEVER walk away. Below is information about medical bills "missing' crucial information for processing...
It might seem impossible that a patient would undergo hip-replacement surgery without anesthesia, but it’s been known to happen. Likewise, there have been cases of surgery to implant a pacemaker without the actual pacemaker. Or at least that’s the impression you might have upon noticing such items glaringly missing on the bills sent by the healthcare provider!
The situation is almost humorous, if it were not so serious. Doctors across the country lose millions of dollars every year due to mismanagement of the billing process. The reasons range from inaccurate charging, such as undercharging for a service or procedure or missing a charge altogether, to sending out claims that are for various reasons deemed inaccurate by the insurance carrier and therefore denied.
These service and item omissions and claims denials generally stem from an unhealthy mixture of unwieldy process, improperly trained employees, and inadequate technology. Fixing the problem, therefore, means determining the underlying causes and then directing resources toward those areas.
Whether the solution involves instituting new procedures and technology, or outsourcing the billing altogether, the benefit should be obvious.
Accurate charge capture and claims denial management processes mean not only improving cash flow, but also protects revenue that the provider is entitled to – and that adds up to a healthier bottom line.
No matter the size of the organization, billing inconsistencies affect all healthcare facilities to some degree – even those that are on top of the problem.
On average, providers lose 5 percent of gross revenues, and that can translate into millions of dollars for a single organization – yes, even the smaller practices over time.
With reams of regulatory rules, disparate software systems, and frequently high employee turnover, opportunities for mistakes to occur in the billing process are many.
At the worst point in the health system’s billing problems, the actual denied claims were measured in yards and feet and inches, depending on the size of the practice.
If you are hesitant in getting help from an outsourced solution on a full time basis, reach out for help on a project-to-project basis. A good Medical Billing Company should leap at the oportunity.
-HFMA, Mar. ‘07
It might seem impossible that a patient would undergo hip-replacement surgery without anesthesia, but it’s been known to happen. Likewise, there have been cases of surgery to implant a pacemaker without the actual pacemaker. Or at least that’s the impression you might have upon noticing such items glaringly missing on the bills sent by the healthcare provider!
The situation is almost humorous, if it were not so serious. Doctors across the country lose millions of dollars every year due to mismanagement of the billing process. The reasons range from inaccurate charging, such as undercharging for a service or procedure or missing a charge altogether, to sending out claims that are for various reasons deemed inaccurate by the insurance carrier and therefore denied.
These service and item omissions and claims denials generally stem from an unhealthy mixture of unwieldy process, improperly trained employees, and inadequate technology. Fixing the problem, therefore, means determining the underlying causes and then directing resources toward those areas.
Whether the solution involves instituting new procedures and technology, or outsourcing the billing altogether, the benefit should be obvious.
Accurate charge capture and claims denial management processes mean not only improving cash flow, but also protects revenue that the provider is entitled to – and that adds up to a healthier bottom line.
No matter the size of the organization, billing inconsistencies affect all healthcare facilities to some degree – even those that are on top of the problem.
On average, providers lose 5 percent of gross revenues, and that can translate into millions of dollars for a single organization – yes, even the smaller practices over time.
With reams of regulatory rules, disparate software systems, and frequently high employee turnover, opportunities for mistakes to occur in the billing process are many.
At the worst point in the health system’s billing problems, the actual denied claims were measured in yards and feet and inches, depending on the size of the practice.
If you are hesitant in getting help from an outsourced solution on a full time basis, reach out for help on a project-to-project basis. A good Medical Billing Company should leap at the oportunity.
-HFMA, Mar. ‘07
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