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Recourse for negligent billing service costing our practice thousands!?

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thatcuteblonde:
This is an unusual question, however I was hoping someone might be able to answer it. I recently took a position with a multispecialty practice who was looking to bring their billing in-house from a biling company after they realized that they had been losing money.

They notified the billing company of our decision not to renew our contract and they held us a clause in the contract that allowed them another thirty days worth of billing. We have been using this time to review the past years worth of claims, info, etc. and have encountered some disturbing and extremely costly errors. One of our physicians is paid based upon the amount collected, so our agreement with the billing company was all payments had to be posted by the end of business every Friday, so that payroll for this physician could be done on Monday. When we noticed a $20,000.00 Medicare check had not been posted, we brought it up to the biling co who insisted it was simply a one time issue of timing and had never happened before, however when we started comparing old reports to what is currently posted on the same date, there was a difference of $8,000.00 just for one week!

In addition to this issue, which could end up costing the practice tens of thousand of dollars in back pay owed, we have found over $20k in charges that were never entered, W/C claims billed with non-existant date of injuries and data entry errors that will result in God knows how much lost revenue. The billing company has given us very limited access to their system, removing the custom report capabilities and other features. When confronted with these errors, mistakes and problems, the owner of the billing company has shrugged them off. Do we have any recourse? They have not kept up with their responsibilties, yet have been compensated and their negligence at this point has cost our practice at least $100k.

Can we sue the billing company or is this unheard of? Has anyone else experienced anything like this before and how did you handle it? 

Pay_My_Claims:
Wow, I would think they can. This is one reason they have E&O insurance. My question is how were they able to do that for so long. If I had a practice and hired a billing service, I would monitor that as I would my in-house biller. Physicians should hire help, but they should also be knowledgeable enough of the job to be able to monitor it. They should have been using the billing service reports to submit to the CPA for accuracy. Good blessings in seeking out what to do. I would surely consult an attorney!!

DONNA:
Our Company recently went thru the same problem with a billing company. When the Dr.decided to bring the billing back in house (where it should always stay so you know what is going on) we found that 90% of claims that had 2nd insurance were never billed to the 2nd. So of cause timly filing was our big issue not just for 2ndry but primary as well. This service was nothing more then a data entry company. No follow ups were done, no errors corrected ,claims were just resubmitted. We also had the problem with  limited access to their program. It was a mess to try and find any sense to what they did.  The Dr. had his attorneys working on this for the longest time but in the end at least $100.000 had to be written off as a loss.   

Michele:
Unfortunately billing services like yours give us good ones a very bad name.  And yours is way too common of a story.  I am not sure but I would think you could sue.  After all, they were supposed to be providing a service and obviously they were not doing what they were supposed to be.

However, in response to Donna, this actually can work both ways.  We went into an office where the billing was done in house and we found that their biller was causing them to lose $500,000 per year.  I know sounds incredulous, but it was true.  She was doing all billing in house, right under the dr's nose, and was costing him a 1/2 million a year.  She didn't bill out ANY inpatient hospital visits or nursing home visits because she didn't like the format the dr gave them to her in.  One of the docs (3 drs, 3 NP's) was director of 3 nursing homes.  They also had one NP that was strictly at the hospital.  Paying her whole salary but never receiving a penny for her work.  Also, she didn't bill any Medicaid because she couldn't get the forms to print properly.  I could go on, but I'm sure you are getting the picture. 

Anyway, the important thing isn't whether the billing is being done in house or out, but whether there is accountability.  Dr's must be aware of what is happening on the business end.  They should know what is being billed out, what is being collected, what is being written off, patient balances, etc.  I am a responsible billing service and I welcome and ENCOURAGE my providers to see my system, view my reports, and be completely aware of all that we are doing.  Mostly because I am very thorough, and I do a good job, and I want them to know how hard I work to collect their money! 

I sympathize with those offices & providers who have had a bad billing service experience. 

Good luck
Michele

P.S. In the example above, we increased that office's receivables 60% within the first 60 days, and kept it there!

Pay_My_Claims:
Agreed Michelle........It's now where the billing is done, its actually WHO is doing it!!! There are so many that jump into thei field because they think its just a data entry push a button sort of field. It's not!!  You can monitor your billing no matter where it is done. When you submit reports to the practice they in turn compare their reports with yours. All providers should monitor the AR whether in-house or outsourced. Its your money, your business...have trust, but never blind trust!!

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