Author Topic: Recourse for negligent billing service costing our practice thousands!?  (Read 13501 times)

Michele

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #15 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
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PMRNC

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #16 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
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Michele

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #17 on: April 25, 2009, 02:46:03 PM »
Absolutely!

Michele
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Pay_My_Claims

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #18 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
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Thanks......I admit I have learned billing is waaaaaaaaay more than I thought it would be as far as starting your own business.

PMRNC

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #19 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
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Pay_My_Claims

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #20 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.

StephD

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #21 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?

Michele

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #22 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.

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PMRNC

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #23 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
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Pay_My_Claims

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #24 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!

thatcuteblonde

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #25 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!

Pay_My_Claims

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #26 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.

PMRNC

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Re: Recourse for negligent billing service costing our practice thousands!?
« Reply #27 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
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Linda Walker
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ChristineS

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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.

thatcuteblonde

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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?