Medical Billing Forum

General Category => General Questions => Topic started by: thatcuteblonde on April 21, 2009, 10:26:38 AM

Title: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on April 21, 2009, 10:26:38 AM
This is an unusual question, however I was hoping someone might be able to answer it. I recently took a position with a multispecialty practice who was looking to bring their billing in-house from a biling company after they realized that they had been losing money.

They notified the billing company of our decision not to renew our contract and they held us a clause in the contract that allowed them another thirty days worth of billing. We have been using this time to review the past years worth of claims, info, etc. and have encountered some disturbing and extremely costly errors. One of our physicians is paid based upon the amount collected, so our agreement with the billing company was all payments had to be posted by the end of business every Friday, so that payroll for this physician could be done on Monday. When we noticed a $20,000.00 Medicare check had not been posted, we brought it up to the biling co who insisted it was simply a one time issue of timing and had never happened before, however when we started comparing old reports to what is currently posted on the same date, there was a difference of $8,000.00 just for one week!

In addition to this issue, which could end up costing the practice tens of thousand of dollars in back pay owed, we have found over $20k in charges that were never entered, W/C claims billed with non-existant date of injuries and data entry errors that will result in God knows how much lost revenue. The billing company has given us very limited access to their system, removing the custom report capabilities and other features. When confronted with these errors, mistakes and problems, the owner of the billing company has shrugged them off. Do we have any recourse? They have not kept up with their responsibilties, yet have been compensated and their negligence at this point has cost our practice at least $100k.

Can we sue the billing company or is this unheard of? Has anyone else experienced anything like this before and how did you handle it? 
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 21, 2009, 11:29:09 AM
Wow, I would think they can. This is one reason they have E&O insurance. My question is how were they able to do that for so long. If I had a practice and hired a billing service, I would monitor that as I would my in-house biller. Physicians should hire help, but they should also be knowledgeable enough of the job to be able to monitor it. They should have been using the billing service reports to submit to the CPA for accuracy. Good blessings in seeking out what to do. I would surely consult an attorney!!
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: DONNA on April 22, 2009, 08:48:13 PM
Our Company recently went thru the same problem with a billing company. When the Dr.decided to bring the billing back in house (where it should always stay so you know what is going on) we found that 90% of claims that had 2nd insurance were never billed to the 2nd. So of cause timly filing was our big issue not just for 2ndry but primary as well. This service was nothing more then a data entry company. No follow ups were done, no errors corrected ,claims were just resubmitted. We also had the problem with  limited access to their program. It was a mess to try and find any sense to what they did.  The Dr. had his attorneys working on this for the longest time but in the end at least $100.000 had to be written off as a loss.   
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on April 22, 2009, 09:14:29 PM
Unfortunately billing services like yours give us good ones a very bad name.  And yours is way too common of a story.  I am not sure but I would think you could sue.  After all, they were supposed to be providing a service and obviously they were not doing what they were supposed to be.

However, in response to Donna, this actually can work both ways.  We went into an office where the billing was done in house and we found that their biller was causing them to lose $500,000 per year.  I know sounds incredulous, but it was true.  She was doing all billing in house, right under the dr's nose, and was costing him a 1/2 million a year.  She didn't bill out ANY inpatient hospital visits or nursing home visits because she didn't like the format the dr gave them to her in.  One of the docs (3 drs, 3 NP's) was director of 3 nursing homes.  They also had one NP that was strictly at the hospital.  Paying her whole salary but never receiving a penny for her work.  Also, she didn't bill any Medicaid because she couldn't get the forms to print properly.  I could go on, but I'm sure you are getting the picture. 

Anyway, the important thing isn't whether the billing is being done in house or out, but whether there is accountability.  Dr's must be aware of what is happening on the business end.  They should know what is being billed out, what is being collected, what is being written off, patient balances, etc.  I am a responsible billing service and I welcome and ENCOURAGE my providers to see my system, view my reports, and be completely aware of all that we are doing.  Mostly because I am very thorough, and I do a good job, and I want them to know how hard I work to collect their money! 

I sympathize with those offices & providers who have had a bad billing service experience. 

Good luck
Michele

P.S. In the example above, we increased that office's receivables 60% within the first 60 days, and kept it there!
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 23, 2009, 06:56:17 AM
Agreed Michelle........It's now where the billing is done, its actually WHO is doing it!!! There are so many that jump into thei field because they think its just a data entry push a button sort of field. It's not!!  You can monitor your billing no matter where it is done. When you submit reports to the practice they in turn compare their reports with yours. All providers should monitor the AR whether in-house or outsourced. Its your money, your business...have trust, but never blind trust!!
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 23, 2009, 04:38:50 PM
As someone else mentioned you should DEFINETLY consult an attorney. Having a lot of experience with contracts however, if you have determined a "Breach" of contract by the billing company than you can deem the contract ended based on that breach..However it's not quite that simple.. Depending on the contract you may or may not have a right to access their system, this is where it gets sticky. Your smallest issue is whether to let them continue for the 30 days, the bigger issue is going to be the transition. I can't really be more specific without actually seeing the contract. I am a paralegal and contracts is sort of my specialty so if you would like to forward it to me I can better guide you (Disclaimer however being I am not an attorney)

Billing companies like that give us a bad name  >:( as Michelle said, and I too have seen it go both ways. I've actually seen more deliberate fraud and abuse IN house but in taking over for other billing companies I notice more Errors.
Someone mentioned E&O insurance.. In a perfect world, however as I have come to learn over the years no matter how much I preach this or discuss this or stress it.. Most billing companies don't put out the money for E&O.

Good luck!!

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 23, 2009, 05:39:27 PM
As someone else mentioned you should DEFINETLY consult an attorney. Having a lot of experience with contracts however, if you have determined a "Breach" of contract by the billing company than you can deem the contract ended based on that breach..However it's not quite that simple.. Depending on the contract you may or may not have a right to access their system, this is where it gets sticky. Your smallest issue is whether to let them continue for the 30 days, the bigger issue is going to be the transition. I can't really be more specific without actually seeing the contract. I am a paralegal and contracts is sort of my specialty so if you would like to forward it to me I can better guide you (Disclaimer however being I am not an attorney)

Billing companies like that give us a bad name  >:( as Michelle said, and I too have seen it go both ways. I've actually seen more deliberate fraud and abuse IN house but in taking over for other billing companies I notice more Errors.
Someone mentioned E&O insurance.. In a perfect world, however as I have come to learn over the years no matter how much I preach this or discuss this or stress it.. Most billing companies don't put out the money for E&O.

Good luck!!

Linda Walker
PMRNC
www.billerswebsite.com

question.......how much responsibility (legally) does an in house biller have for the provider she works for?? What rights do a provider have when his biller's lack of knowlege or (maybe intentional) creates financial ruin for a provider?

Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on April 23, 2009, 09:39:54 PM
I think unless you can prove intentional fraud by the in house biller, the provider's only recourse is firing the biller.  If you have an employee who is not doing their job properly, or to the best of their ability then it is your responsibility to know it.  When someone doesn't do their job, they get fired (unless you work for a bank or an insurance company, then you get a bonus!).  Sorry I couldn't leave the politics out of it.  If a provider has an in house biller who is losing him money then he needs to get her out of their ASAP and get someone in there who can maximize his accounts receivables and collect all that should be collected for his services. 

Reality is most offices are losing money due to some lack in their billing practices but the providers are completely unaware.  Like Linda said, educating them is so important, but getting them to know they need to be educated ....  uggghhhhh!

Michele
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 24, 2009, 06:33:45 AM
Quote
question.......how much responsibility (legally) does an in house biller have for the provider she works for?? What rights do a provider have when his biller's lack of knowlege or (maybe intentional) creates financial ruin for a provider?

If you review some case files of providers brought up on charges you will find a lot of the office managers or billers are right there with them. They hold just as much liability and responsibility.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 24, 2009, 06:51:14 AM
Quote
question.......how much responsibility (legally) does an in house biller have for the provider she works for?? What rights do a provider have when his biller's lack of knowlege or (maybe intentional) creates financial ruin for a provider?

If you review some case files of providers brought up on charges you will find a lot of the office managers or billers are right there with them. They hold just as much liability and responsibility.

Linda Walker
PMRNC
www.billerswebsite.com

That's scary!! Gotta keep on my toes!!
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 24, 2009, 07:48:53 AM
It is scary. If you think about it the law is clear on fraud and abuse and not only does it state it's illegal to submit a fraudulent claim or commit abuse.. but that anyone BILLING SHOULD know, so it's not all about "mistakes" For example I read one case where the biller knew the provider was billing for visits when he was not in the office, but maybe she felt compelled since he was the boss, anyway both of them ended up in court with hefty fines/penalties and I think even some jail time. Some of those cases are pretty scary. I used a lot of cases to help me put together my contract .. good idea huh?  ;D
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on April 24, 2009, 12:17:26 PM
I misunderstood the question, I thought you were asking more if the provider could hold the biller legally responsible if they did a poor job and caused the provider to lose money. 

Linda is right, the biller cannot do something that he/she knows is not legal just because the 'boss' tells them to.  If they know (which they need to!) that it is illegal then they have to not do it, even if it means losing their job.  Finding another job is better than jail time.

We had a provider that was charged with fraud, billing for patients that were not seen.  Being an outside billing service we obviously did not know the patients had not come into the office.  We cooperated fully with the investigation, showing all the documentation to prove that we were provided with which obviously indicated the patient had been seen. 

You have to protect yourselves and knowledge is the best way.

Michele
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 24, 2009, 05:42:06 PM
Quote
We had a provider that was charged with fraud, billing for patients that were not seen.  Being an outside billing service we obviously did not know the patients had not come into the office.  We cooperated fully with the investigation, showing all the documentation to prove that we were provided with which obviously indicated the patient had been seen.

There was a billing company in NC I believe that wasn't so lucky. You see they had to go to court because the laws on fraud/Abuse include verbiage that billers "Should know" apparently what happened is the blling company suspected and rather than cease operation on their billing they decided to conduct their own investigation, in court they lost because they SHOULD know. I know they tried to appeal the decision but I never found out what happened in the end.
I caught a provider who was supposed to be "supervising" a biofeedback tech, I got a daysheet faxed to me for a days worth of biofeedback services, problem was my client had called me from Florida to tell me he was having a wonderful vacation, that very morning.  :o I contacted him on his cell and told him and he said he has done that before and "no one would know" Well I knew and that's when I terminated him, did NOT bill the charges received that date and turned them both in. I also documented everything leading up to me finding out to CMA.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 24, 2009, 06:18:46 PM
oooooh, I live in NC  :o
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 24, 2009, 07:44:18 PM
I'm pretty sure it wasn't you.. you are too smart for that!  ;D 

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on April 24, 2009, 08:31:43 PM
We've terminated providers too, for doing things that they didn't feel were 'wrong' but we knew they were.  We advised them, they didn't agree, so we had no choice but to terminate our contract.  We had one fairly large group that we suspected were padding up their billing.  We questioned them about a couple of suspicious billings and didn't like the answers.  We had no proof, just suspicion, but I won't work for anyone who is not all the way above board.

In the other case I cited, we had no idea!  Everything looked normal, nothing suspicious whatsoever.  She was mental health and she would even comment on the patients!  (Nothing that would violate HIPAA, just vague comments)  We were completely in shock at first.  When we found out (at the Grand Jury hearing) what she was being accused of we were absolutely amazed.  She didn't seem capable of it.  I'm still in disbelief many years later.  Her husband was extremely prominent, she had small children, she seemed extremely competent and caring about her patients.   ???  Leaves you scratching your head.  (The insurance company knew from our records we were duped as well since her paperwork was all in place.)  That is why it is important that we keep very good records of our interactions with our providers as well. 

Michele
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 24, 2009, 09:20:29 PM
Plus you want to make sure you have a good out clause in your contract that will allow you to CEASE services immediately upon suspicion of any fraud/abuse.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on April 25, 2009, 02:46:03 PM
Absolutely!

Michele
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 25, 2009, 05:21:17 PM
I'm pretty sure it wasn't you.. you are too smart for that!  ;D 

Linda Walker
PMRNC
www.billerswebsite.com

Thanks......I admit I have learned billing is waaaaaaaaay more than I thought it would be as far as starting your own business.
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 25, 2009, 07:58:23 PM
Quote
Thanks......I admit I have learned billing is waaaaaaaaay more than I thought it would be as far as starting your own business.

You'd love working at an insurance company! When I started billing I found it to be MUCH easier than the other side of the fence, education/knowledge wise I was good, it was just adjusting to thinking from the opposite end that was harder!

Speaking of liability, it's funny this came up. My own OBGYN called me this morning asking if I could come in and do an audit because she seems to be bringing in too much money  ???  ???  well that was my first thought but seems the billing person might be doing some funny stuff, I know the biller but what I didn't know was this provider was paying her an hourly rate ON TOP of a percentage.. a big NO NO here in NY. So before I give her an answer I want her to talk to one of the attorney's out here I work with because she (doctor) could find herself in some hot water over this even if she wasn't aware.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 26, 2009, 12:26:10 PM
I almost did work for a couple of insurance companies, but declined the offers. Some were customer service jobs (NOT!!). That's curious...i guess her reason for doing it, is because she benefits from the percentage. I was hourly so trying to do something fraudulent would be ridiculous. I hope things go well for her.
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: StephD on April 27, 2009, 10:26:29 AM
Does anybody send month end reports such as the outstanding AR?  If so, what other reports do you send to the provider's office?
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on April 27, 2009, 07:50:18 PM
Sometimes we give our providers a transaction journal report to show all activity on their account.  We basically give them any reports that they request.

Michele
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 28, 2009, 07:13:01 AM
I used to provide a custom A/R report by carrier and patient balance, pending claims log, Monthly claim submission report, if needed a report with accounts (patient balances) over 90 days to refer to collections, and a claims summary report.
I used to charge extra for custom reports unless they were reports already created.

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 28, 2009, 07:19:18 AM
I used to provide a custom A/R report by carrier and patient balance, pending claims log, Monthly claim submission report, if needed a report with accounts (patient balances) over 90 days to refer to collections, and a claims summary report.
I used to charge extra for custom reports unless they were reports already created.

Linda Walker
PMRNC
www.billerswebsite.com

Very good reports expecially the pending claims report. Providers should ask for them. Even if you have an in-house biller......he should know the status of his reimbursements!
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on April 29, 2009, 09:32:50 AM
It's very true that an unknowledgable 'biller' can do serious damage, regardless of whether they are in house or part of a billing company. Some companies both billing and private practices hire an individual who isn't a biller/coder. The person is nothing more than a CSR doing data entry and calling it billing and the damage inflicted can be severe.

I started working on our old A/R (the claims billed prior to things being outsourced) and found things that no competant biller would have done. Diagnosis codes that aren't reflected on the fee slip and services that shouldn't have been billed. For example, one dos showed the patient had an NCV and EMG, the diagnosis code billed with it was anxiety, depression and arthritis! I pulled the fee slip and saw that the correct diagnosis codes were on the fee slip but the biller had not bothered to enter them, simply billing the E & M codes along with the diagnostics. Each CPT code was generated on a separate CMS-1500 and billed out to Medicare! Found another where the pt was in an auto accident, hurt his back, the M.D. did an NCV on his wrist, fee slip had a dx of carpal tunnel and the 'biller' entered the ICD-9 code for migranes!!

Alot of doctors, practices and billing companies think they are saving themselves money by hiring an individual willing to work for less money per hour but when it comes down to it, the money they lose in just a month due to cases like what I've mentioned above will cost them far more!
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on April 29, 2009, 09:45:02 AM
It's very true that an unknowledgable 'biller' can do serious damage, regardless of whether they are in house or part of a billing company. Some companies both billing and private practices hire an individual who isn't a biller/coder. The person is nothing more than a CSR doing data entry and calling it billing and the damage inflicted can be severe.

I started working on our old A/R (the claims billed prior to things being outsourced) and found things that no competant biller would have done. Diagnosis codes that aren't reflected on the fee slip and services that shouldn't have been billed. For example, one dos showed the patient had an NCV and EMG, the diagnosis code billed with it was anxiety, depression and arthritis! I pulled the fee slip and saw that the correct diagnosis codes were on the fee slip but the biller had not bothered to enter them, simply billing the E & M codes along with the diagnostics. Each CPT code was generated on a separate CMS-1500 and billed out to Medicare! Found another where the pt was in an auto accident, hurt his back, the M.D. did an NCV on his wrist, fee slip had a dx of carpal tunnel and the 'biller' entered the ICD-9 code for migranes!!

Alot of doctors, practices and billing companies think they are saving themselves money by hiring an individual willing to work for less money per hour but when it comes down to it, the money they lose in just a month due to cases like what I've mentioned above will cost them far more!

Oh My God!!! girl that is just a mess.
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on April 29, 2009, 10:40:12 AM
What's worse is that even if "employee's" of a practice they don't even know the liability they are assuming!

Linda Walker
PMRNC
www.billerswebsite.com
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: ChristineS on May 05, 2009, 10:27:22 PM
I have no clue.. However I was working for a Podiatry Group where we did billing for 15 Providers..  I was working in the collections department and calling on my claims to find out where our money was... There was like 10 different checks ranging from $600 to a couple thousand dollars where they had never been posted. I confronted my super and she found them sitting in limbo because one of the old payment posters left and never finished the job.. That was a pain and could have been alot of money lost.
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on May 18, 2009, 10:53:24 AM
I've found charges that were never posted, charges that were posted under the wrong providers, the wrong dates and/or the wrong CPT codes. We still haven't gotten any cooperation from the billing service in regards to fixing these errors and the owner of the billing company actually told the doctor that he didn't want to correspond with me anymore because he didn't like the fact that I was pointing out all of their errors and mistakes!  :o  :o

We have limited access to their system, they've even disabled the custom reports button so that we cannot run specifics on reports. I can't correct these mistakes because I do not have the permission to do so in their system, however I have found charges that should never have been billed that were billed out and paid, then deleted leaving only a credit on the patient's account from the insurance overpayment. I'm concerned that this can be viewed as fraud and the doctor says the billing services isn't held liable, that as the owner of the practice, he would be. Anyone have any suggestions on what I can do at this point? It's in our contract that they will continue to do the follow up/collections on everything billed by them, however they aren't fixing their own mistakes and certainly haven't lived up to their end of the contract.

Is there anything I can do to ensure the doctors here do not get penalized?

Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on May 18, 2009, 04:01:38 PM
I don't know why, but I am always amazed when people behave so poorly.   ???

The only thing I can suggest that you do is consult a lawyer.  See what your legal options are.  I really don't know if you have any recourse.  In the meantime I would do all you could from your end to correct any overpayments that you can.  Document everything, continue to 'point out their errors'.  If they were the least bit serious about what they do they would want to know the problems.  I know that I want to know whenever any of my employees make a mistake, even if it is just an innocent error.  This is my business and I want to know what my employees are doing and if they are making mistakes I need to decide if it is something that they need to be talked to about, or if they need education on something.

Maybe somebody else has a suggestion for you.

Michele


Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on May 18, 2009, 05:32:30 PM
I hate to side against you..but I have always told my billers NEVER correspond...get involved or get in the middle of another contract.
Essentially that is what you have done.

Now the best advice I can give is to let the billing company and the provider duke out their contract and you stay as far away from it as possible. JMO!
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on May 19, 2009, 02:40:15 PM
Unfortunately it's not just a matter of contracting, there are several cases that could be considered fraud. They have insisted on maintaining the follow up/collections on the accounts they've billed out however they have stopped responding to our inquiries entirely. We have lost patients because of billing errors and patient's being unjustly billed so we don't want to lose anymore by leaving the billing company to 'handle' their mistakes, especially when their idea of handling them seems to be ignoring them.

Just today a patient sent in a payment for $150.00 based on a statement they received, however when I looked into the account, I found the patient wasn't given the in-network rate that we had agreed to give her, $150 worth of coding errors were billed to the patient when they should have been written off, $22.00 in insurance payments were not posted and $14.97 in co-insurance was billed to the patient for an adjustment billed under our physical therapist! Not only did should she never have received a statement but she had a credit of $64.67 on her account and had stopped coming in for treatment because of the statements and billing errors.

The billing company didn't catch any of these errors and when it was brought to their attention, they had no interest in resolving it, simply saying oh, sorry. When I brought these problems up to the owner of the company, he asked not to correspond with me. I'm stuck between a rock and a hard place here when I'm not getting any cooperation from the billing company and the doctors want these issues resolved. How can I just ignore it and hope the billing company will somehow shape up?
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on May 19, 2009, 02:47:48 PM
By law and by involving yourself you now really are obligated to report all instances of fraud to the appropriate agency, that's why it's best to not get in middle. When I take over a practice from another billing company anything PRIOR to the date of service I start with I don't touch. If I need information it's up to the provider to get it for me. I know that sounds harsh but that's for your own protection.
I do understand some things can't be overlooked and will affect future billings, but if there is blatant fraud/abuse going on and you now know about it your liability is now the same as everyone else's involved. I would state that to the provider and let him/her know that these instances must be reported, document the conversation or put it in writing.
Unfortunately that's all you can do if no one is going to cooperate with you to fix it.
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on May 20, 2009, 08:09:59 AM
Unfortunately, I'm not doing this as a billing service but as a direct employee of the practice (in house biller). I know these are errors and not intentional instances of fraud, however billing service has stopped responding to my inquiries entirely. I have kept records of my attempts to notify them of their errors, indicating the services were not rendered, were billed incorrectly, etc. and that immediate action is required. Does anyone know if the doctor can be held liable if the fee slip shows the correct services byut the billing company entered something different?
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Pay_My_Claims on May 20, 2009, 11:35:41 AM
i'm not 100% sure, but it seems to me he would be liable. I furnish a standard wheelchair, and they bill for a bariatric. I receive the EOB and payment that shows the billing company upcoded the claim therefore increasing my revenue. I don't do a corrected claim and keep the additional funding.....

As stated this is just only how I view it, I may be mistaken.
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on May 20, 2009, 07:20:05 PM
I don't want to scare you, but being an employee holds NO less liability than if you were the actual one doing the billing..here is why. .. ONCE you learn or spot the error you become libel and obligated to report..technically speaking.
I've seen a lot of court cases where the office manager/biller, billing company AND doctor all went down ..equal liability even if you didn't send the claims.
The law is very clear that ignorance is never an acceptable defense.

If I were in your shoes.. I would advise your employer that you will not be a party to any of accounts or have any involvement with the accounts you know are fraudulent or erroneous. The fact that the doctor is not too concerned or maybe he is not wanting to deal with it..bothers me.  :-\
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on May 21, 2009, 08:18:27 AM
The doctor is concerned with these matters but the billing company has flat out refused to cooperate with us which has left us in a difficult place. Per our contract they are to handle the collections and follow up for everything billed out by them but once we decided not to renew our contract, our representative (who made all of these errors) has stated she has other responsiblities now and will handle these problems when she can.

We'd take over doing everything however they refuse to provide us with a back up of our information and trying to handle things without it would be next to impossible. To make matters worse, they have been billing patients for mutually exclusive codes. I don't know how to look into the accounts as requested by the doctor, without happening upon these instances of fraud and errors yet at the same time, I don't think it's fair for the doctor to be penalized when everything done on our end was on the up and up (i.e. our feeslips indicate CPT code 64405x2 units and the billing company billed out 64445x2 units and 64405x1 unit, the insurance paid for all three codes, the 'biller' then deleted the 64445x2 out of their system, left the payment for the incorrect codes and no record of the charge or payment received for the services actually rendered which should have been billed at 2 units to begin with!)  :o

I brought this to their attention but they have not corrected it and I don't have the rights to change any information in their system. I feel it would be unfair to report it as fraud and yet I can't simply stand by and say oh well!  :(
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on May 21, 2009, 09:46:32 AM
I hate to say this now because I feel like I'm pouring lemon juice on you, but I always encourage providers to have either complete access to their billing, including backups, or their own records.  These situations don't arise often, but as you can see, when it happens to you it's a big problem.  I'm still astounded at the behavior of the billing service.  They make us concientious hard working services look bad.   >:(

Michele
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on May 21, 2009, 10:06:39 AM
I completely agree, the number of errors and mistakes that I've caught are astounding and the fact that they have taken no corrective measures is even worse. The attitude of the billing companies owner is probably the most bothersome, to keep this biller on staff after the constant problems, mistakes, errors and whatnot is shocking and to make things even worse, two of their other clients are friends of my boss and their accounts are being handled by the same set of people.

I'm about to sit down with my boss shortly and advise him to seek out legal counsel. The instances of fraud that I previously brought to the billing company over a week ago haven't been taken care of yet and if we get audited we're looking at enough errors, penalties and fines to bankrupt the practice. Companies like this one definitely give honest reputable billing services a bad rap.
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on May 21, 2009, 12:55:35 PM
At this point..I wouldn't want that billing company touching anything.. the doctor has just cause to exit the contract and should be doing so right now.. also again.. where the "fraud" is considered.. cover all your butts and report it before it's too late, the more you try to "fix" it or hold them accountable to "fix" it the worse it's going to be.
If I were you I would send a letter to the billing company certified mail and I would contact all the carriers and try to rectify this situation within your office.. Don't let that billing company touch anything.. you could be looking at an even bigger mess if they go back and cook the books to cover their own asses.

Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: Michele on May 22, 2009, 06:28:32 AM
I was thinking the same thing Linda, but she had said they don't have any records, so they have no way of handling what the billing service has billed.  Personally I would have pulled it several weeks ago, but if they have no access to any previous billing I'm not sure how they will handle it.

Michele
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on May 22, 2009, 10:49:50 AM
I STRONGLY advise the practice to get an attorney to handle this, this is way too much to be put on an employee of the practice, a lawyer can step in and take the necessary steps to obtain the info needed. BUT if the provider is sweating over getting caught with something.. and it were me.. I'd be quickly looking for another job.
JMO
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on May 28, 2009, 10:02:15 AM
And that is exactly what I'm doing. They are not taking any corrective measures here outside of expecting me to find all of these mistakes and notify the billing company. We don't have anyway to take it back ourselves which is unfortunate and I got brought into this mess at the very end of things, a month before their contract with the billing company was scheduled to end. The 'office manager' has no billing experience whatsoever and was to be monitoring what was going on.

In the two months that I've been here I've found everything from misposted payments; $61.00 posted as $610.00, bills for services not rendered, patients billed for mutually exclusive codes, MMSE (mini mental status exams) billed using an 96116 (hour long neurological exam) despite the disclaimer in the CPT book at the begining of that section and so much more. It seems the more I bring these problems to light the more the office manager hassles me for little things like arriving at 7:31 when start time is 7:30. Unfortunately there seems to be no real concern for the issues here other than the 'don't get caught' mentality Linda mentioned and the woman who should have picked up on half of these things months ago getting catty because I am making her look bad.

At this point there isn't much more I can do. I have written letters to the insurance carriers for the fraudent charges I have come across and notified them of these errors. In addition, I've kept copies of my attempts to notify the billing company and the doctor. It's so frustrating when it seems like it's getting harder and harder to find an office where the doctor's actually care and the other employees are capable of doing their jobs instead of resenting the people who do.  :( :( Anyone know of a position available in Arizona? LOL.
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: PMRNC on May 28, 2009, 10:32:32 AM
I have had a few clients like that.. the "word" audit seems to provoke an interesting response... sort of like yelling "FIRE"..

keep documenting things and do what you can do. The carriers you notified of errors.. that might come back to bite them enough to take responsibility..you did right thing, some of those carriers if it's fraud (not error) are not going to just.. OH Ok.. oopsie..just cut us a check and we're good.. some of them might put a red flag in there which will affect future reimbursements, others will take payments from future claims and you are going to have yet another mess when the requests come in for overpayments or even.. du dum dum.. an audit or two.

These offices eventually either get shut down or see the errors of their ways.. one or the other.  I'm sure you are also dealing with some irate patients? 
Title: Re: Recourse for negligent billing service costing our practice thousands!?
Post by: thatcuteblonde on June 01, 2009, 09:23:38 AM
Oh LORD YES! I have found patient credits ranging from $60-$3k+ and other patients accounts that have been so badly mangled that I've had to actually go through each date of service long hand, cross referencing the EOB's and double checking the patient payments! I can't even begin to tell you how many patients must have decided not to return after receiveing a statement. There are overpayments on one date of service and owed amounts on the next, patients billed for services denied as mutually exclusive or coding errors on behalf of the biling service. It's definitely a mess in that regard!  ::) Unfortunately some of these credits are over a year old and the majority of the patients aren't even aware of it because of all the mistakes.

The only brightside is this has given me some great experience regarding identifying and resolving issues which will be helpful in future positions where someone, be it a billing company like the one we had the displeasure of using or a biller employed by the doctor's office, has made a mess of things! LOL.

Thank you so much to everyone who's helped me out with this!  ;)