Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: QDbilling on February 10, 2012, 08:59:54 PM

Title: Terminating
Post by: QDbilling on February 10, 2012, 08:59:54 PM
If there is NO contract between a billing service and "the company", what is the billing service obligated to give them as far as records/data when the relationship is terminated?  It's a relationship gone sour due to questioning of CPT coding, misuse of a modifier, and coding being done by an uncertified office employee. 
Title: Re: Terminating
Post by: PMRNC on February 11, 2012, 07:58:09 AM
Hard to say. What does the contract state they are to be given? Hopefully it was addressed.
Title: Re: Terminating
Post by: camedbill on February 11, 2012, 12:45:58 PM
Agreed! back to the contract..
Title: Re: Terminating
Post by: PMRNC on February 11, 2012, 01:07:32 PM
I say to refer back to the contract because I've seen contracts where even the smallest of details were not covered and if challenged will always be in the favor of the provider and what is best for their business dealings. I have seen cases where billing companies were made to make data fully available to the provider even with balances owed to the billing company which is why it's so important to address ALL of these issues in the contract itself.
Title: Re: Terminating
Post by: QDbilling on February 11, 2012, 01:39:57 PM
There is NO CONTRACT.  Nothing.  Nada.  Zip.   
Title: Re: Terminating
Post by: PMRNC on February 12, 2012, 11:31:32 AM
I'm sorry to say if there's no contract, and if challenged, you could be forced to turn whatever they want over.  IN MY OPINION.. I would try to cooperate with much of their requests and avoid legal entanglements.  Also, I would have to say you need to cover your butt. You mention some problems with coding, etc. When you ended the relationship (or if they did) was their written terminations in place? Were reasons stated? Did you bill out ANYTHING you knew or SHOULD have known were fraudulent or could be interpreted as fraudulent?  By keeping them from their data that COULD be construed as an admission of guilt on your end.  I don't want to assume anything but it would help to have more information.  If nothing more, hopefully, you won't take on a client without a contract next time. Your not the first to have learned this lesson the hard way! We all have learned similar lessons this way, I know I have, and that's why my contract went from 3 pages to 13!!
Title: Re: Terminating
Post by: QDbilling on February 13, 2012, 09:50:18 PM
It is a bit of a story.  Should I post it all or send you an email? 
Title: Re: Terminating
Post by: PMRNC on February 14, 2012, 06:45:04 AM
Quote
It is a bit of a story.  Should I post it all or send you an email? 

That's up to you, if you don't mind posting it, it could help others. I've seen many a scenario, none that would surprise me much  ??? ;)
Title: Re: Terminating
Post by: QDbilling on February 14, 2012, 03:13:26 PM
Years ago I was approached by a business owner to do the billing for 4 physicians.  The previous girl set them up with the software and clearinghouse, she just couldn't keep up with the work load.  They offered to pay me by the claim and had months of back billing to be done asap.  The next time we met they brought boxes of work to get done and a computer.  I got started and caught them up.  The general manager in the office was the one doing the coding.  Attached to the face sheet was the DOS, ICD's, and CPT's.  With a sticky note.  They were always 4 months behind in getting billing to me.  Years went by.  The GM stopped dropping off the files and began sending them through the mail.  They began using spreadsheets for the billing info.  The GM left.  The office manager was fired.  Physicians came and went.  Things seemed  to be improving but I was beginning to question how the whole operation worked when I started to get billing info with a Q6 modifier.  The GM is not a certified coder.  I questioned using a Q6 and was told that it was correct.  Then denials started flowing in last year.  Reviews were being sent out every week.  For the same service, different patient.  I started doing research and found that the CPT code they were using could not be billed with the other service performed beginning in July.  I made a phone call to a reimbursement consultant in the fall to ask her about billing a service provided in the home.  She began asking a lot of questions.  Her advice was to stop billing, give them whatever reason I wanted to, but to do it "next week".  I was a bit surprised.  Medicare, and other insurance carriers, had been paying these guys for years.  If the way claims were being billed was wrong, wouldn't they be getting denied payment?  She told me they were flying "under the radar" due to how the practice was set up.  They are not set up as a practice, but as individual physicians, and they all work for this company.  Paychecks are made to the physician but automatically deposited in the company bank account.  The physicians are then paid by the company for their services.  There is a "billing service".  I am not that billing service.  I happen to be a subcontractor.  I've never received a W2 or 1099 from them.  I do report my income and pay taxes on it. 

The business owner called me last month and told me that billing was being brought in house.  He wants a copy of the database so that they can see if a patient has been seen within the last 3 years, so they know which H&P code to use, as well as to have for possible audits. 

Thoughts? 



Title: Re: Terminating
Post by: PMRNC on February 14, 2012, 03:23:47 PM
Wow.. and OUCH.   

Do you want my honest to goodness advice? Give them a copy of their database and wipe your hands of this mess now. If it gets to be an argument you really don't have much to stand on.  Even though you do NOT have a contract, i would still FORMALLY terminate this relationship with the reasons in a letter via certified mail. THIS will cover you.   Now to address something you can't fix now, but can learn from for future reference.  THE moment you suspected there was a problem was the VERY moment you should have stopped billing. The law is VERY clear that billers MUST know what they are doing and ignorance is not an excuse. The moment you suspected was the moment your liability tripled with each claim you sent.  The way to have correctly handled it was to send a letter with your concerns and "PEND" operations until the issue was resolved. Next thing was to consult with your contract and compliance plan to see what you should do next. and finally if no resolution was made, a letter terminating services with reasons why, and sent certified mail would cover you.   As it stands now, with no contract, nor proper procedure in place both yourself and the billing company you sub-contract for are not out of the woods. That is why I suggest you comply with what they want.  If I were you, also, I would terminate the relationship with the billing company for also not really properly setting you up as a contractor.  Did you have a contract with them?   

I say keep them happy and run, make sure you keep ALL of your own source documents and database copies as you are required to do JUST in case.
Title: Re: Terminating
Post by: QDbilling on February 14, 2012, 03:37:24 PM
The business set up a billing company, but I don't work for them either.  It's like it's just...there.  The clearinghouse has them set up under this billing company.  Other than that, I don't know what else it does.  A way to cover the company? 

The owner wants me to bill several more claims for a doctor that they did not set up on their new system because he quit.  He also wants me to follow-up on old accounts to clear up any open balances.  I wish I could show someone a claim, explain everything, and have a definite answer as to whether they are doing something wrong or not.  Do you know anyone that I can get in touch with?  Today?  :)  Or does it even matter?  Send a copy of the database with a letter.  End of story? 

Title: Re: Terminating
Post by: PMRNC on February 14, 2012, 04:00:23 PM
Quote
The business set up a billing company, but I don't work for them either.  It's like it's just...there.  The clearinghouse has them set up under this billing company.  Other than that, I don't know what else it does.  A way to cover the company? 

Who do you work for? Who is paying you? 

Quote
I wish I could show someone a claim, explain everything, and have a definite answer as to whether they are doing something wrong or not.  Do you know anyone that I can get in touch with?  Today?  :)  Or does it even matter?  Send a copy of the database with a letter.  End of story? 

I see so many things wrong from the setup structure of the business and add to that your suspicions alone, I frankly would NOT be doing another thing for them, you could be setting yourself up for a big fall. JMHO.

Title: Re: Terminating
Post by: QDbilling on February 14, 2012, 04:13:36 PM
I work for the company itself.  Not the doctors.  Not the billing company.  The MAIN company.  They pay me under my name. 

So then, how do I get out of this with complying?  They don't use my software but said they are going to buy a copy of it (after suggesting that I might "rent" mine to them, or even better, sell my laptop to them). 

Refuse billing the new claims for the physician who quite.  Refuse doing any follow-up work.  Refuse sending patient statements, one last time.  In my letter, can I state "for personal reasons"?  This wouldn't be complying with what they want.  But give them a copy of the database? 

I just want to be done with this. 
Title: Re: Terminating
Post by: PMRNC on February 14, 2012, 05:23:00 PM
Where I am confused is they are paying "you", (company) and it sounds like they are paying you as "employee"..? How are you setup tax wise, maybe that's what I should have asked from beginning ?    I think this matters because if you were an employee/contractor that means didn't they pay for the software/computer, etc.. wouldn't it belong to them to begin with?   

Since you said you wanted to be done with it, my advice is still the same, how you go about it might be different depending on your legal status with the company you work for.. If you are an employee than I would think you would want to terminate your employment status, if you are legally setup as a contractor than I would think you need to terminate the contractual relationship and this is where you would send letter as to your reasons and IMHO I would actually state your suspicions as generally as possible to avoid arguments/disputes.   

I'm just confused as to why there would be a question of why they shouldn't get their data if it was a subcontract setup.
Title: Re: Terminating
Post by: QDbilling on February 14, 2012, 05:46:53 PM
I know.  It's been confusing since I started.  They provided me with everything to get started.  They brought a computer over with the software already installed with existing data.  After that, I always upgraded the software on my own, every year or 2.  They did not pay for any of the upgrades.   The program is registered to me.  When I bought a new system they didn't want their old one back.  Of course, I just paid for the upgrade to the newest 5010 compliant version of software.  I have a single user license. 

They pay me, under my name.  I don't have a company name.  They don't take any money out for taxes.  They don't send any tax documents to me.  I never signed any documents for tax purposes, nor anything else for that matter.  I've never been an employee anywhere that didn't have take taxes out of my paycheck.  I've received W2's and 1099's from previous employers. 

What does this make me? 

Title: Re: Terminating
Post by: QDbilling on February 14, 2012, 05:49:29 PM
As for the data:  give them a printable file with all open balances?  or a back up for which they have no software to open it with?  I guess it's not really a question at this point.  I can give them both. 
Title: Re: Terminating
Post by: billingandscanning on February 15, 2012, 07:17:40 AM
How did you file your taxes with the IRS if you did not have a W2 or a 1099? I agree with Linda, this company sounds very suspicious to me.
Title: Re: Terminating
Post by: PMRNC on February 15, 2012, 09:23:44 AM
Quote
What does this make me?

Very very vulnerable.  At this point I think you need to either completely revamp your relationship with them ..meaning if you want to stay, get everything properly setup, contracts, tax info, etc. At this point in time you basically don't "exist" to them and that COULD be a blessing for you in this situation as you can walk away w/out stating any reasons and be done.  If they give you a problem, I cannot stress enough how important it would be for you to speak with a lawyer and/or your sate Labor board.   IF I were in your shoes, I'd probably tell them "see ya".  Your way too vulnerable here with NO legal protection at all.
Title: Re: Terminating
Post by: QDbilling on February 15, 2012, 06:22:12 PM
I keep good accounting records and filed as self-employed. 

I'm not staying.  They told me last month they were bringing the billing in house.  They chose to go with a different software company than what I use and I was told that someone in the office was taking classes on billing.  Anyway, I do feel very vulnerable.  I'm a sitting duck. 

The owner called again and wants me to file 7 more claims for them because they did not set up the doctor who quit in October on their new billing software.  There are also 100+ claims missing from Medicare's system (a problem between the clearinghouse and Medicare after 5010 went into effect) that he wants me to track down.  And they want me to enter all payments coming in so that my database, when I give it to them, is up to date.  Oh, and send another batch of patient statements. 

I'm losing sleep. 
Title: Re: Terminating
Post by: PMRNC on February 16, 2012, 09:43:55 AM
Quote
I keep good accounting records and filed as self-employed.

How you are setup is sort of a problem because they look at you like a sub-contractor where as you are setup within your own structure as a business (self employed).. there's a big difference between the two. Sub contractors have certain IRS rules for both the company hiring them and the sub-contractor. A small example is that they supplied the computer/software, that hurts you with IRS deductions naturally.  It's good you have accounting records as that will help you in regards to being paid what is owed but it's not going to help much in terms of leaving them since they consider you one thing and you are setup as another.

Quote
I'm not staying.  They told me last month they were bringing the billing in house.  They chose to go with a different software company than what I use and I was told that someone in the office was taking classes on billing.  Anyway, I do feel very vulnerable.  I'm a sitting duck.

I agree that's probably the BEST option for YOU.  Since you have no contract with them, I would try to leave on a good note, maybe cite personal family emergency , etc.. and give them what they need.   If they have a different software, they cannot expect you to provide a data conversion, but it would be in your best interest to give them a copy of the data, how they access that data is ON them. I would also give them a full set of reports.  Do the best you can to maintain the relationship at least for a reference if needed in the future.

<<The owner called again and wants me to file 7 more claims for them because they did not set up the doctor who quit in October on their new billing software.  There are also 100+ claims missing from Medicare's system (a problem between the clearinghouse and Medicare after 5010 went into effect) that he wants me to track down.  And they want me to enter all payments coming in so that my database, when I give it to them, is up to date.  Oh, and send another batch of patient statements. >>

So long as you are being compensated AND you want to do this, I don't see a problem with this unless any of the previous coding/billing issues are encountered.  BUT.. I understand you want to get out and if you don't want to do the remaining work your best option, IMO, is to cite some sort of family emergency and wash your hands. They are looking at a long conversion process anyway since they have gone in house. 7 claims and follow up on 100 claims is certainly not going to make or break them in this process. Side note observation:  WHAT kind of practice decides to go in-house during a HUGE transition like 5010?? seems a little NUTTY to me!!

Quote
I'm losing sleep. 

I'll bet. But look at this as a learning experience and just try to keep the relationship good because the reference WILL be a great thing to have.  Hopefully you have learned that the better way to do this is as your own business, and most importantly.. NEVER EVER EVER work without a contract!  Get an attorney and make sure you come up with a good contract that will cover you.  Sorry you have to go through this, but if it makes you feel better, I don't know any billing company who has not had at least one problem client that they have learned from, it's a hard lesson, but it can serve a great value for your business!
Title: Re: Terminating
Post by: QDbilling on February 23, 2012, 07:07:46 PM
Guess who sent me a 1099 for 2011?  Very odd. 

Since I received partial payment for the 100 claims that are hung up somewhere between the clearinghouse and Medicare I should track them down.  Should I charge a fee for an open balance report and back up?  I couple of people suggested I should do that. 

I don't plan on continuing in this line of work.  I've been at it for over 20 years and the only time I loved my job was when I worked for a wonderful surgeon who truly cared about his patients, his family, and even me.  I'm ready for the next chapter.  Or should I say, the next book.  :) 
Title: Re: Terminating
Post by: Michele on February 27, 2012, 10:08:50 AM
This is a tough one.  I'm one to always do what I should do, what is my responsibility.  However, since this is a strange situation, it isn't that clear.  Also, there is no contract to outline what is and isn't your responsibility.  So with that being said, in this instance, I think I would not do any work that I didn't need to do.  Even if I had originally submitted the claims, they can be resubmitted by the person now doing the billing.  Curious if others feel the same.
Title: Re: Terminating
Post by: PMRNC on February 27, 2012, 04:21:31 PM
From going back to all your posts, I'd have to say I would have washed my hands a while ago with this one.  That being said, my opinion is to lose them, just make sure you terminate professionally and do whatever you can to keep the relationship in tact.. not advocating "lying" but sometimes in cases like this it's best to cite a personal or family emergency .. if you had a contract and there were not those other issues than I would be more specific on a termination plan, but there's so much grey here with you not having a contract I don't want to see you rock the boat and get in deeper.
Title: Re: Terminating
Post by: QDbilling on March 01, 2012, 12:32:12 PM
Okay then.  It's settled.  I am going to send a back up of their data with a letter of termination for personal reasons.  And believe me, that's not a lie.  Is there a "sample" termination letter out there to help me write mine?  And, if they do call wanting help or have questions about specific accounts, I can politely decline, yes? 
Title: Re: Terminating
Post by: Michele on March 06, 2012, 06:31:51 AM
I am not aware of any sample termination letters but I would just keep it short and simple.  Get right to the point and just state that it is your notice of termination.  I would answer any questions regarding any work done by me.