Medical Billing Forum
Billing => Billing => : Nora Hopkins October 10, 2014, 12:03:18 PM
-
Our medical biller has been working from home for the past five years with, what turns out to be, a faulty VPN. Because this person never checked on claims (person is the practice manager in a small office), hundreds of claims, possibly for two years, never got filed. Or were rejected for various reasons and the biller just went in and marked "negative adjustment" in the ledger for the entire amount. How can we, or can we, get these claims paid? We went back to January 2014 and rebilled JAN-JULY 2014 at the end of September. The first batch of denials are coming in. What recourse can we take? I am the physician's wife, newly retired from public education, currently enrolled in the online medical billing course. We need help now that is beyond my level of understanding. Thank you in advance for any help.
-
Call your network manager right away for each insurance company and explain the situation and ask if they can work with you on this. They don't have to, as timely filing rules are included in your agreements with the insurers, but if there's anything that can be done, it's through your network managers. Unfortunately, anything that is over a year old is very unlikely to be payable at this point and you will almost certainly have to write off the charges for those claims. Focus on getting the claims under a year old paid first.
-
Agree with Shanbull but have to add.. GET an experienced and trained biller NOW or you will continue to have same problems. Review your contracts and also find out if they had Errors & Omissions.. if you find negligence you need to address that within the confounds of your contract with this billing company. If you did NOT have a contract, let that be a lesson .. a very costly one.
-
Agree with everything that has been said, but I have a question...why are the claims denying again? Is it for timely filing, or is there still something wrong with how they are being submitted?
-
I must not have had my caffeine fix.. because this first sentence flew right by me:
Our medical biller has been working from home for the past five years with, what turns out to be, a faulty VPN.
I can't help but ask... HOW HOW HOW.. 5 years is a long time.. this was an "employee"?
-
Linda, I took that part to mean that the biller is an office manager for a DIFFERENT practice, and was doing THIS practice's billing work remotely as an independent contractor...and not very well, obviously.
What kind of biller just writes off claims that deny without investigating them/telling the doctor there is a problem with the VPN, or whatever? Sheesh...
-
I have put Nora in touch with a consultant/biller with oodles of years experience. Hopefully they will click and the practice will get the help that they need.