General Category > General Questions
Recourse for negligent billing service costing our practice thousands!?
thatcuteblonde:
It's very true that an unknowledgable 'biller' can do serious damage, regardless of whether they are in house or part of a billing company. Some companies both billing and private practices hire an individual who isn't a biller/coder. The person is nothing more than a CSR doing data entry and calling it billing and the damage inflicted can be severe.
I started working on our old A/R (the claims billed prior to things being outsourced) and found things that no competant biller would have done. Diagnosis codes that aren't reflected on the fee slip and services that shouldn't have been billed. For example, one dos showed the patient had an NCV and EMG, the diagnosis code billed with it was anxiety, depression and arthritis! I pulled the fee slip and saw that the correct diagnosis codes were on the fee slip but the biller had not bothered to enter them, simply billing the E & M codes along with the diagnostics. Each CPT code was generated on a separate CMS-1500 and billed out to Medicare! Found another where the pt was in an auto accident, hurt his back, the M.D. did an NCV on his wrist, fee slip had a dx of carpal tunnel and the 'biller' entered the ICD-9 code for migranes!!
Alot of doctors, practices and billing companies think they are saving themselves money by hiring an individual willing to work for less money per hour but when it comes down to it, the money they lose in just a month due to cases like what I've mentioned above will cost them far more!
Pay_My_Claims:
--- Quote from: thatcuteblonde on April 29, 2009, 12:32:50 PM ---It's very true that an unknowledgable 'biller' can do serious damage, regardless of whether they are in house or part of a billing company. Some companies both billing and private practices hire an individual who isn't a biller/coder. The person is nothing more than a CSR doing data entry and calling it billing and the damage inflicted can be severe.
I started working on our old A/R (the claims billed prior to things being outsourced) and found things that no competant biller would have done. Diagnosis codes that aren't reflected on the fee slip and services that shouldn't have been billed. For example, one dos showed the patient had an NCV and EMG, the diagnosis code billed with it was anxiety, depression and arthritis! I pulled the fee slip and saw that the correct diagnosis codes were on the fee slip but the biller had not bothered to enter them, simply billing the E & M codes along with the diagnostics. Each CPT code was generated on a separate CMS-1500 and billed out to Medicare! Found another where the pt was in an auto accident, hurt his back, the M.D. did an NCV on his wrist, fee slip had a dx of carpal tunnel and the 'biller' entered the ICD-9 code for migranes!!
Alot of doctors, practices and billing companies think they are saving themselves money by hiring an individual willing to work for less money per hour but when it comes down to it, the money they lose in just a month due to cases like what I've mentioned above will cost them far more!
--- End quote ---
Oh My God!!! girl that is just a mess.
PMRNC:
What's worse is that even if "employee's" of a practice they don't even know the liability they are assuming!
Linda Walker
PMRNC
www.billerswebsite.com
ChristineS:
I have no clue.. However I was working for a Podiatry Group where we did billing for 15 Providers.. I was working in the collections department and calling on my claims to find out where our money was... There was like 10 different checks ranging from $600 to a couple thousand dollars where they had never been posted. I confronted my super and she found them sitting in limbo because one of the old payment posters left and never finished the job.. That was a pain and could have been alot of money lost.
thatcuteblonde:
I've found charges that were never posted, charges that were posted under the wrong providers, the wrong dates and/or the wrong CPT codes. We still haven't gotten any cooperation from the billing service in regards to fixing these errors and the owner of the billing company actually told the doctor that he didn't want to correspond with me anymore because he didn't like the fact that I was pointing out all of their errors and mistakes! :o :o
We have limited access to their system, they've even disabled the custom reports button so that we cannot run specifics on reports. I can't correct these mistakes because I do not have the permission to do so in their system, however I have found charges that should never have been billed that were billed out and paid, then deleted leaving only a credit on the patient's account from the insurance overpayment. I'm concerned that this can be viewed as fraud and the doctor says the billing services isn't held liable, that as the owner of the practice, he would be. Anyone have any suggestions on what I can do at this point? It's in our contract that they will continue to do the follow up/collections on everything billed by them, however they aren't fixing their own mistakes and certainly haven't lived up to their end of the contract.
Is there anything I can do to ensure the doctors here do not get penalized?
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