Medical Billing Goofs - medical billing news

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.

Michael Russell