Author Topic: Rant and Question  (Read 4546 times)

blhoffman

  • Full Member
  • ***
  • Posts: 112
Rant and Question
« on: April 09, 2010, 11:22:55 AM »
The company I am working for currently has billing consultants in (they were here before I started). Now this company had one biller originally who had this place a mess. After they let her go when their A/R was 5 million in the whole, they hired the consultants. They hired 4 people for billing and collecting, trying to clear up the mess. This is all great.

But I had a request from them to bill a claim that was past timely, to the primary to get a new dated remit to bill the secondary. Now I had already reviewed the claim, the timesheet, the auth., the units, the code billed and billed amount to fee schedule. This was a clean claim. Clean. I refused because my name would be on that claim and I would be held accountable for my part. I cannot say my boss made me do it and be off scott free. Doesn't happen that way. So I said no and why. She didn't push the issue but it has been unpleaseant ever since.

I explained that I cannot rebill clean claims just to get a new remit. The claim would most likely deny for timely and it is in the fraud and abuse guidelines that we cannot do it for this reason. No valid changes - no billing. She became angry with me and since then it has been a hard enviroment for over half a year. This one consultant has even thrown files down on my desk in front of my face, on my hands while I was typing and working another account. Right on top of the file I currently have open. Has anyone else had this problem?

Pay_My_Claims

  • Guest
Re: Rant and Question
« Reply #1 on: April 09, 2010, 12:05:21 PM »
Well according to previous posts  you might get an adjustor who is having a good day and get the claim paid :-)


DMK

  • Hero Member
  • *****
  • Posts: 680
Re: Rant and Question
« Reply #2 on: April 09, 2010, 12:43:26 PM »
Love you Charlene!  Maybe she could slip the consultant a Midol and rub her shoulders for a minute, and say "thought you might be having a bad day and could use this"?

blhoffman

  • Full Member
  • ***
  • Posts: 112
Re: Rant and Question
« Reply #3 on: April 09, 2010, 12:56:35 PM »
Last week, same consultant told another biller to remove one unit from the claim to rebill for a new dated remit to bill the Secondary. Another timely issue. We did the service, claim was clean. She wants a new remit. Biller told her no, not unless it was justified.

I had a write off for timely and was questioned on it. Claim was truly untimely and I researched everything but it was our error and I had nothing to appeal. Consultant told me we had 180 days to bill and it was timely. I calmly explained that we had 180 days for initial billing but only 90 days for corrections. She said all billing is 180 days. I explained that is not what the timely filing guidelines say. She called another biller and asked if they had a copy of timely guidelines and was told no. I advised I had it saved to my desk top. I printed it and highlighted the area and brought it back to the consultant. She read it and without looking at me said I could go back to my seat.

At that point I had been working there 11 days. She had been working for the company 9 months and this is our biggest payer, usually $900,000 or more a month. I left there wondering what is going on. Why did a company hired to fix the billing and collect the money, after 9 months, not know the timely filing guidelines for our biggest - nearly primary payer?

Pay_My_Claims

  • Guest
Re: Rant and Question
« Reply #4 on: April 09, 2010, 01:35:38 PM »
B, What is the issue about filing the claim??  I have in all seriousness gotten timely filing overturned. I have filed to NC Medicaid claims that were 2 years old, and our timely filing is 1 year. It all depends on the circumstances. I know we don't and CAN'T file medicare just to receive a denial (DME when client isn't eligible for services), but if the claim is payable, and the only issue is that the claim was never filed (or was it). What is the opposition if its not "ilegal" to file past the deadline??? If it is in your contract that you must file within 60 days, and you don't does it mean you CAN'T file. or does it mean, they WON'T pay??

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: Rant and Question
« Reply #5 on: April 09, 2010, 01:50:04 PM »
True, with all the time you spent researching, and I do appreciate your adhering to the rules, why not try.  The worst they'll say is no.  If the insurance company questions you, you can honestly tell them you were TOLD to bill it.  As long as you're not monkeying with claims (changing dates of service or dx or modifiers) to get them paid, you're not doing anything illegal.

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Rant and Question
« Reply #6 on: April 09, 2010, 01:54:36 PM »
Ok, so they want you to change the units and rebill? I'm not real clear on the circumstances reading this myself, but if they want you to change the claim but documentation doesn't support the change, you are 100% correct, that's fraud. Since you mention you need ANOTHER remit, I am still curious as to the claim status on the clean claim previously submitted, maybe I am not reading this correctly.

Quote
Well according to previous posts  you might get an adjustor who is having a good day and get the claim paid :-)

Charlene, wasn't it you that said to let this rest? if you are going to make such a statement where clearly you are chastising me for telling you what really goes on.. Ever hear of the saying "Don't shoot the messenger"?  You yourself say you have gotten claims overturned that were previously rejected for timely filing.. did you not? Were they erroneously denied? What was basis for your appeal? Seems to me it would be more relevant to share that then a nasty quip meant towards me.    
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

Pay_My_Claims

  • Guest
Re: Rant and Question
« Reply #7 on: April 09, 2010, 02:22:32 PM »
Linda, I was going to reply, but it would be useless. If you believe that, I'm sorry but I refuse to keep going back and forth. I told you before my replies to you were taken out of hand and context, and only you can see fault in my post. You didn't see it in the other one, and you won't see it in this one. Nuff said for me.

blhoffman

  • Full Member
  • ***
  • Posts: 112
Re: Rant and Question
« Reply #8 on: April 09, 2010, 02:26:14 PM »
Situation is Primary does not pay. We do not expect payment but require a correct denial to submit to Secondary for payment. Claim was denied by Primary correctly, but never submitted to Secondary timely and when submitted it denied for timely filing. We know it was untimely. She just wants us to rebill the Primary to get new remit to rebill Secondary so we are timley according to the date on remit. BUT we billed a clean claim and there is absolutely nothing wrong with the original claim to resubmit a new one to the Primary. I searched for anything, something to allow me to get the money. This was my situation.

My co-worker is the same, except last week she told her to just remove one of the services we did perform to have a change on the claim so we can rebill. The original claim was clean, we did do the service and unless we are going to remove services for all patients we can't just decide to remove and not get paid for services randomly to get new remits so we can get updated remits to submit to Secondary. Right? I mean that is false billing. Especially the timesheets for our workers are on file and clearly shows we did the service and we clearly paid that worker for the service on her paycheck. Am I right?

I understand appealing timely. I do it all the time but I have to have a leg to stand on even is it is a splinter of a leg. I just pulled in $129,160 for one patient that 4 people have touched for a year and couldn't get the money. I worked it for 2 months and got most of it. I am appealing the other 5 months and by the time I am done I hope to have all $250,000 or her. I am appealing the timely as we speak, because I have the insurance law to back my appeal.

dekenn

  • Jr. Member
  • **
  • Posts: 77
Re: Rant and Question
« Reply #9 on: April 09, 2010, 03:38:56 PM »
Even if you do resubmit the secondary, wouldn't it just deny as duplicate?  In my experience, yes, you might get the new "date" on the explanation of benefits, but it will show being denied as duplicate, instead of not being covered.

blhoffman

  • Full Member
  • ***
  • Posts: 112
Re: Rant and Question
« Reply #10 on: April 09, 2010, 03:48:05 PM »
My situation yes, that is also what I told this consultant. It would just deny as dup. That was months ago.

She told my co-worker to change the units of services rendered which would change the claim and would possibly get payment. Might I add the secondary is a Medicaid plan. I researched it and it is fraud under the False Claims Act because of knowingly misrepresenting the charges.

They are out of here soon. Funny thing, the company I am working for hired another billing consultanting company to come in for a week and audit this billing consulting company to see if they were on the up and up. That was three weeks ago and they were told yesterday by Corporate who made a special visit that they are out at the end of May. Thank goodness someone is paying attention.

Don't get me wrong, there are exceptionally great billing consultants that get the job done legally and are a big help. Then there are others that leach on and won't let go of a company because its money and make false problems to continue the contract and at the same time not have the knowledge of how to pull that company out of the mess they are in. It can go both ways. Sorry for all the rant, its just been building up. Thanks.

Pay_My_Claims

  • Guest
Re: Rant and Question
« Reply #11 on: April 09, 2010, 03:51:47 PM »
OK, now I fully understand what you were saying......I thought you NEVER filed the primary at all ...

PMRNC

  • Hero Member
  • *****
  • Posts: 4254
    • One Stop Resources & Networking for Medical Billers
Re: Rant and Question
« Reply #12 on: April 09, 2010, 04:08:23 PM »
Quote
My situation yes, that is also what I told this consultant. It would just deny as dup. That was months ago.

She told my co-worker to change the units of services rendered which would change the claim and would possibly get payment. Might I add the secondary is a Medicaid plan. I researched it and it is fraud under the False Claims Act because of knowingly misrepresenting the charges.

Ahh ok.. I was waiting to hear more on this.. changing the claim indeed would be fraud! You are 100% correct.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

DMK

  • Hero Member
  • *****
  • Posts: 680
Re: Rant and Question
« Reply #13 on: April 09, 2010, 04:19:41 PM »
Good girl!  You really clarified that for me.  You are correct and have strong legs to stand on!

blhoffman

  • Full Member
  • ***
  • Posts: 112
Re: Rant and Question
« Reply #14 on: April 15, 2010, 07:55:17 PM »
Okay - No worries this is a Laugh not a Rant!
 ;D       ;D       ;D        ;D       ;D        ;D

So corporate found that the first consultant is not doing a good job. They are terminating the contract as of 05/31/2010. They hired the consultanting company that came in to audit their work. Their job is to clean up and help transition the billing operation to NJ.

So we have old consultants and new consultants working in same room. Oh yes, corporate did not wait to hire the new consultants. When the new consultant tells us to do something or not to and then leaves the room - the old consultants immediately comes over and asks what we were told. Then tells us not to listen to her. Then the new comes back and asks why it isn't done and we say ask so-and-so.

Its very confusing, but I have to say there is a certain comedy to the whole situation. It really can't be described unless you are living it. I know I'm losing my job to this transition. Can't be helped, its good for the company but this new situation is just bizarre and no one knows which way to turn.

I have decided after watching this that I will NEVER take on a consulting job in my life where there is another contracted consultant still working in same building.