Author Topic: Recourse for negligent billing service costing our practice thousands!?  (Read 13499 times)

Michele

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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


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PMRNC

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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!
Linda Walker
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thatcuteblonde

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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?

PMRNC

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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.
Linda Walker
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thatcuteblonde

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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?

Pay_My_Claims

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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.

PMRNC

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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.  :-\
Linda Walker
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thatcuteblonde

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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!  :(

Michele

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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
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thatcuteblonde

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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.

PMRNC

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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.

Linda Walker
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Michele

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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
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PMRNC

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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
Linda Walker
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thatcuteblonde

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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.

PMRNC

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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? 
Linda Walker
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www.billerswebsite.com