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Recourse for negligent billing service costing our practice thousands!?

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Michele:
I don't know why, but I am always amazed when people behave so poorly.   ???

The only thing I can suggest that you do is consult a lawyer.  See what your legal options are.  I really don't know if you have any recourse.  In the meantime I would do all you could from your end to correct any overpayments that you can.  Document everything, continue to 'point out their errors'.  If they were the least bit serious about what they do they would want to know the problems.  I know that I want to know whenever any of my employees make a mistake, even if it is just an innocent error.  This is my business and I want to know what my employees are doing and if they are making mistakes I need to decide if it is something that they need to be talked to about, or if they need education on something.

Maybe somebody else has a suggestion for you.

Michele

PMRNC:
I hate to side against you..but I have always told my billers NEVER correspond...get involved or get in the middle of another contract.
Essentially that is what you have done.

Now the best advice I can give is to let the billing company and the provider duke out their contract and you stay as far away from it as possible. JMO!

thatcuteblonde:
Unfortunately it's not just a matter of contracting, there are several cases that could be considered fraud. They have insisted on maintaining the follow up/collections on the accounts they've billed out however they have stopped responding to our inquiries entirely. We have lost patients because of billing errors and patient's being unjustly billed so we don't want to lose anymore by leaving the billing company to 'handle' their mistakes, especially when their idea of handling them seems to be ignoring them.

Just today a patient sent in a payment for $150.00 based on a statement they received, however when I looked into the account, I found the patient wasn't given the in-network rate that we had agreed to give her, $150 worth of coding errors were billed to the patient when they should have been written off, $22.00 in insurance payments were not posted and $14.97 in co-insurance was billed to the patient for an adjustment billed under our physical therapist! Not only did should she never have received a statement but she had a credit of $64.67 on her account and had stopped coming in for treatment because of the statements and billing errors.

The billing company didn't catch any of these errors and when it was brought to their attention, they had no interest in resolving it, simply saying oh, sorry. When I brought these problems up to the owner of the company, he asked not to correspond with me. I'm stuck between a rock and a hard place here when I'm not getting any cooperation from the billing company and the doctors want these issues resolved. How can I just ignore it and hope the billing company will somehow shape up?

PMRNC:
By law and by involving yourself you now really are obligated to report all instances of fraud to the appropriate agency, that's why it's best to not get in middle. When I take over a practice from another billing company anything PRIOR to the date of service I start with I don't touch. If I need information it's up to the provider to get it for me. I know that sounds harsh but that's for your own protection.
I do understand some things can't be overlooked and will affect future billings, but if there is blatant fraud/abuse going on and you now know about it your liability is now the same as everyone else's involved. I would state that to the provider and let him/her know that these instances must be reported, document the conversation or put it in writing.
Unfortunately that's all you can do if no one is going to cooperate with you to fix it.

thatcuteblonde:
Unfortunately, I'm not doing this as a billing service but as a direct employee of the practice (in house biller). I know these are errors and not intentional instances of fraud, however billing service has stopped responding to my inquiries entirely. I have kept records of my attempts to notify them of their errors, indicating the services were not rendered, were billed incorrectly, etc. and that immediate action is required. Does anyone know if the doctor can be held liable if the fee slip shows the correct services byut the billing company entered something different?

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