Starting a Medical Billing Business > Starting Your Own Medical Billing Business
Terminating
PMRNC:
I'm sorry to say if there's no contract, and if challenged, you could be forced to turn whatever they want over. IN MY OPINION.. I would try to cooperate with much of their requests and avoid legal entanglements. Also, I would have to say you need to cover your butt. You mention some problems with coding, etc. When you ended the relationship (or if they did) was their written terminations in place? Were reasons stated? Did you bill out ANYTHING you knew or SHOULD have known were fraudulent or could be interpreted as fraudulent? By keeping them from their data that COULD be construed as an admission of guilt on your end. I don't want to assume anything but it would help to have more information. If nothing more, hopefully, you won't take on a client without a contract next time. Your not the first to have learned this lesson the hard way! We all have learned similar lessons this way, I know I have, and that's why my contract went from 3 pages to 13!!
QDbilling:
It is a bit of a story. Should I post it all or send you an email?
PMRNC:
--- Quote ---It is a bit of a story. Should I post it all or send you an email?
--- End quote ---
That's up to you, if you don't mind posting it, it could help others. I've seen many a scenario, none that would surprise me much ??? ;)
QDbilling:
Years ago I was approached by a business owner to do the billing for 4 physicians. The previous girl set them up with the software and clearinghouse, she just couldn't keep up with the work load. They offered to pay me by the claim and had months of back billing to be done asap. The next time we met they brought boxes of work to get done and a computer. I got started and caught them up. The general manager in the office was the one doing the coding. Attached to the face sheet was the DOS, ICD's, and CPT's. With a sticky note. They were always 4 months behind in getting billing to me. Years went by. The GM stopped dropping off the files and began sending them through the mail. They began using spreadsheets for the billing info. The GM left. The office manager was fired. Physicians came and went. Things seemed to be improving but I was beginning to question how the whole operation worked when I started to get billing info with a Q6 modifier. The GM is not a certified coder. I questioned using a Q6 and was told that it was correct. Then denials started flowing in last year. Reviews were being sent out every week. For the same service, different patient. I started doing research and found that the CPT code they were using could not be billed with the other service performed beginning in July. I made a phone call to a reimbursement consultant in the fall to ask her about billing a service provided in the home. She began asking a lot of questions. Her advice was to stop billing, give them whatever reason I wanted to, but to do it "next week". I was a bit surprised. Medicare, and other insurance carriers, had been paying these guys for years. If the way claims were being billed was wrong, wouldn't they be getting denied payment? She told me they were flying "under the radar" due to how the practice was set up. They are not set up as a practice, but as individual physicians, and they all work for this company. Paychecks are made to the physician but automatically deposited in the company bank account. The physicians are then paid by the company for their services. There is a "billing service". I am not that billing service. I happen to be a subcontractor. I've never received a W2 or 1099 from them. I do report my income and pay taxes on it.
The business owner called me last month and told me that billing was being brought in house. He wants a copy of the database so that they can see if a patient has been seen within the last 3 years, so they know which H&P code to use, as well as to have for possible audits.
Thoughts?
PMRNC:
Wow.. and OUCH.
Do you want my honest to goodness advice? Give them a copy of their database and wipe your hands of this mess now. If it gets to be an argument you really don't have much to stand on. Even though you do NOT have a contract, i would still FORMALLY terminate this relationship with the reasons in a letter via certified mail. THIS will cover you. Now to address something you can't fix now, but can learn from for future reference. THE moment you suspected there was a problem was the VERY moment you should have stopped billing. The law is VERY clear that billers MUST know what they are doing and ignorance is not an excuse. The moment you suspected was the moment your liability tripled with each claim you sent. The way to have correctly handled it was to send a letter with your concerns and "PEND" operations until the issue was resolved. Next thing was to consult with your contract and compliance plan to see what you should do next. and finally if no resolution was made, a letter terminating services with reasons why, and sent certified mail would cover you. As it stands now, with no contract, nor proper procedure in place both yourself and the billing company you sub-contract for are not out of the woods. That is why I suggest you comply with what they want. If I were you, also, I would terminate the relationship with the billing company for also not really properly setting you up as a contractor. Did you have a contract with them?
I say keep them happy and run, make sure you keep ALL of your own source documents and database copies as you are required to do JUST in case.
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