Author Topic: Electronic Billing!  (Read 2369 times)

medauthor

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Electronic Billing!
« on: September 01, 2010, 03:00:54 PM »
Me venting here... I thought one of the benefits of electronic billing for us billers was that the ins co could not state " No claim on file"!!!  >:(

I have had 2 ins carriers in the past week state "No claim on file" and yet I have an acceptance report from both payers!!!
Michelle Rimmer, CHI, CPMB
President-Professional Medical Billers Association
Owner-ABA Therapy Billing Services
Author, 'Medical Billing 101' and 'Coding Basics: Understanding Medical Collections

Pay_My_Claims

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Re: Electronic Billing!
« Reply #1 on: September 01, 2010, 06:11:28 PM »
KILL the insurance companies!!

PMRNC

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Re: Electronic Billing!
« Reply #2 on: September 01, 2010, 06:37:54 PM »
I have the same problem with a few claims from BCBS..just this week too!
Linda Walker
Practice Managers Resource & Networking Community
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www.billerswebsite.com

Anand

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Re: Electronic Billing!
« Reply #3 on: September 02, 2010, 12:49:45 AM »
Me venting here... I thought one of the benefits of electronic billing for us billers was that the ins co could not state " No claim on file"!!!  >:(

I have had 2 ins carriers in the past week state "No claim on file" and yet I have an acceptance report from both payers!!!
Persoanally it happened to me in few instances, coudnt remember the payor but when i told them that there has been an acceptance report. The ins Rep put me on hold and stated that it was there but due to some syst gltich they havent taken it into the adjudication system. Hence she has taken and assigned me with a ref#. In most cases when i f/u with clm they were paid..just a try before resubmitting the claim....:)

midwifebiller

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Re: Electronic Billing!
« Reply #4 on: September 15, 2010, 08:52:20 PM »
Unfortunately, this happens to us quite a bit.  Just this week I was on the phone with a rep who insisted the claims were not on file, when I had a clearinghouse report that stated claims had been received and accepted.  This was the second time these claims had been submitted and the member was very irritated with us, thinking we were not doing our job since she could not see the claims on the insurance company's website.  A few things that help:

Have the rep look in the EDI file.  There is some big, black hole where e-claims get lost, and they can usually be found here.  Most reps are unwilling to look here, but if you are persistent they will eventually take a look.

Ask to speak with a supervisor.  I don't have time for greenhorn reps or those who cannot speak fluent English.

Ask to be transferred to the EDI department.  They have found many of our claims and also identified the problem so that it (theoretically) does not happen again.

As for the above claims, the rep continued to insist the claims were not on file (end-of-conversation-please-hang-up attitude).  I told him again that I had an e-report, and that if he couldn't find the claims I needed to speak with his supervisor.  He finally checked the EDI file.  And found the claims.  When I asked what the problem was, I got: "Oh, it's just one of those little glitches.  The claim was not routed to the correct department."  Grrr.
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

DMK

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Re: Electronic Billing!
« Reply #5 on: September 16, 2010, 10:47:53 AM »
Ahhhhh, the beauty of doing things via computer!  Aren't you just so excited at the prospect of all providers going to EHR (electronic health records)!   "I'm sorry, but we have no record of you......no, you didn't just have coronary bypass surgery.....no, I'm not finding it in the system....I'll transfer you to my supervisor in Bangladesh, one moment please, your call is very important to us!"     

Can you smell the sarcasm?

Michele

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Re: Electronic Billing!
« Reply #6 on: September 16, 2010, 07:57:40 PM »
Do they have wine in Bangladesh?
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PMRNC

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Re: Electronic Billing!
« Reply #7 on: September 17, 2010, 05:45:56 AM »
Quote
"I'm sorry, but we have no record of you......no, you didn't just have coronary bypass surgery.....no, I'm not finding it in the system....I'll transfer you to my supervisor in Bangladesh, one moment please, your call is very important to us!"

LOL  Well I've already had 2 problems with my kids doctor over EHR. In fact I've been researching on whether a patient can opt out or not.. so far all I can find are provider rules.. nothing about patient's rights? I don't want EHR..I don't want to take chances.. I would rather get good ol fashion records from my doctors! JMO

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

midwifebiller

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Re: Electronic Billing!
« Reply #8 on: September 17, 2010, 12:41:22 PM »
I agree!  And that is why I request hard copies of all medical records--and billing records--for each family member.  Too many mistakes. When my son was 6 years old, he was hospitalized for testing for possible diabetes.  The tests came back negative, but the receptionist (yes, the receptionist) coded the claim 250.10 - Diabetes with ketoacidosis.  Big difference!
Kelli Sugihara, CPMB
Midwife Billing & Business, LLC
www.midwifebilling.com

PMRNC

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Re: Electronic Billing!
« Reply #9 on: September 18, 2010, 10:53:51 AM »
Yeah, I want NO part of my records being transferred around that way..NONE..  There has to be a way for consumer/patient's to OPT out.  I took my daughter for some blood work, and the receptionist put us in the room and brought up her record on a screen, left room..we sat there for an hour and then finally I went to someone and said..hey why are we still here?? The doctor came in and sat down and said, Oh yes we have to discuss some of these tests..and proceeded to tell us that her medication was not really working and we needed to switch...?? talk about confused.. I said "Doc, we didn't have the blood work yet" and he says..Oh yes she did..it's right here.. see?   UMM no, I don't care what your little computer says..she didn't have blood drawn you idiot! And the medication he mentioned.. for a heart condition!  It was her name on the screen, her DATE of birth..for all intense purposes THAT was her electronic medical record... I ended up leaving because the doctor was more interested in his EHR record being RIGHT that he wouldn't listen so we got up and walked away but not before I could tell him that he had better get to the bottom of the confusion and errors in her record and get back to me when it was fixed.  I called 2 weeks later after getting another doctor who DID not have EHR and they told me "Yes it was fixed" but I still have no way to know unless I request it? Like I said, I'm still researching this and trying to figure a way to opt out and get a copy of that EHR..it is mine isn't it?
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com