General Category > General Questions
Recourse for negligent billing service costing our practice thousands!?
Michele:
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
PMRNC:
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
PMRNC
www.billerswebsite.com
Michele:
Absolutely!
Michele
Pay_My_Claims:
--- Quote from: PMRNC on April 24, 2009, 10:44:18 PM ---I'm pretty sure it wasn't you.. you are too smart for that! ;D
Linda Walker
PMRNC
www.billerswebsite.com
--- End quote ---
Thanks......I admit I have learned billing is waaaaaaaaay more than I thought it would be as far as starting your own business.
PMRNC:
--- Quote ---Thanks......I admit I have learned billing is waaaaaaaaay more than I thought it would be as far as starting your own business.
--- End quote ---
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
PMRNC
www.billerswebsite.com
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