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Recourse for negligent billing service costing our practice thousands!?

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Pay_My_Claims:
i'm not 100% sure, but it seems to me he would be liable. I furnish a standard wheelchair, and they bill for a bariatric. I receive the EOB and payment that shows the billing company upcoded the claim therefore increasing my revenue. I don't do a corrected claim and keep the additional funding.....

As stated this is just only how I view it, I may be mistaken.

PMRNC:
I don't want to scare you, but being an employee holds NO less liability than if you were the actual one doing the billing..here is why. .. ONCE you learn or spot the error you become libel and obligated to report..technically speaking.
I've seen a lot of court cases where the office manager/biller, billing company AND doctor all went down ..equal liability even if you didn't send the claims.
The law is very clear that ignorance is never an acceptable defense.

If I were in your shoes.. I would advise your employer that you will not be a party to any of accounts or have any involvement with the accounts you know are fraudulent or erroneous. The fact that the doctor is not too concerned or maybe he is not wanting to deal with it..bothers me.  :-\

thatcuteblonde:
The doctor is concerned with these matters but the billing company has flat out refused to cooperate with us which has left us in a difficult place. Per our contract they are to handle the collections and follow up for everything billed out by them but once we decided not to renew our contract, our representative (who made all of these errors) has stated she has other responsiblities now and will handle these problems when she can.

We'd take over doing everything however they refuse to provide us with a back up of our information and trying to handle things without it would be next to impossible. To make matters worse, they have been billing patients for mutually exclusive codes. I don't know how to look into the accounts as requested by the doctor, without happening upon these instances of fraud and errors yet at the same time, I don't think it's fair for the doctor to be penalized when everything done on our end was on the up and up (i.e. our feeslips indicate CPT code 64405x2 units and the billing company billed out 64445x2 units and 64405x1 unit, the insurance paid for all three codes, the 'biller' then deleted the 64445x2 out of their system, left the payment for the incorrect codes and no record of the charge or payment received for the services actually rendered which should have been billed at 2 units to begin with!)  :o

I brought this to their attention but they have not corrected it and I don't have the rights to change any information in their system. I feel it would be unfair to report it as fraud and yet I can't simply stand by and say oh well!  :(

Michele:
I hate to say this now because I feel like I'm pouring lemon juice on you, but I always encourage providers to have either complete access to their billing, including backups, or their own records.  These situations don't arise often, but as you can see, when it happens to you it's a big problem.  I'm still astounded at the behavior of the billing service.  They make us concientious hard working services look bad.   >:(

Michele

thatcuteblonde:
I completely agree, the number of errors and mistakes that I've caught are astounding and the fact that they have taken no corrective measures is even worse. The attitude of the billing companies owner is probably the most bothersome, to keep this biller on staff after the constant problems, mistakes, errors and whatnot is shocking and to make things even worse, two of their other clients are friends of my boss and their accounts are being handled by the same set of people.

I'm about to sit down with my boss shortly and advise him to seek out legal counsel. The instances of fraud that I previously brought to the billing company over a week ago haven't been taken care of yet and if we get audited we're looking at enough errors, penalties and fines to bankrupt the practice. Companies like this one definitely give honest reputable billing services a bad rap.

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