Handling Billing Chores

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Handling Billing Chores:

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The following is a truncated excerpt of an article by The Morning News, which illustrates the frustrations and challenges encountered in the medical billing industry. This is only an excerpt.

Medical Billing No Easy Chore

Complicated System Frustrates Patients, and Doctors

This article was published on Saturday, September 23, 2006 5:24 PM CDT in Business

By John L. Moore

The Morning News

Clarindia Elliott was treated at Gravette Medical Center in 2003. A few weeks ago she got two bills from a collection agency for $71.05 and $55. Not a lot of money, but she couldn't believe it. The bills should have been sent to Medicare and BreastCare of Arkansas and paid years ago. Eliott said she never received a hospital bill at the time. Now, a collection agency is coming after her for money she’s pretty sure she doesn’t owe.The services for those bills happened so long ago, she’s not even sure exactly what they were for. Elliott said she is refusing to pay the bills until the collection agency can prove she owes them.

BILLING ERRORS

In 2003, Consumer Reports surveyed 23,000 people on satisfaction with hospital stays and of the 11,000 people who reviewed itemized bills of their hospital stay, 5 percent found major errors. Those patients with out of pocket expenses of $2,000 or more were twice as likely to find billing errors, according the report. Those errors may be built into the system at some medical facilities, said Nora Johnson, a medical billing advocate.

Hospitals and independent physicians all have their own set of policies regarding payment. Some allow payment plans and some don't. Some will send the bill to an outside collection agency sooner than others. St. Mary’s Hospital in Rogers, for example, does offer interest-free payment plans for patients, Shepphard said.

“A lot of hospitals want a lot of money in advance, before you leave,” Johnson said. “Patients need to know, if they are insured, that they are responsible for the deductible, but anytime they’re asking for anything outrageous, you need to make the hospital put it in writing.” Johnson said that asking them to put it in writing and have a hospital official sign it will help insure that the money they’re asking for is appropriate, she said. Those bills that come years afterward, often from a collection agency can be the most frustrating for patients, Johnson said.

Read full article and comments: The Morning News Business Medical Billing, No Easy Chore!

Addressing the Issues

Billing mistakes can be costly. Medical billing and collection problems on behalf of the patient, or the physician's office are not uncommon. They usually happen as a result of oversight, error, or unfortunately in some cases as a result of incompetence. Billing patients, health insurances and Medicare/Medicaid for medical services involves a complex system of numerical codes for various diagnoses and procedures. Reimbursement is based on coordinating and properly submitting those codes. Cash flow and financial success depends on proper reimbursement. Rejected claims can be costly and frustrating!

Mistakes Best Avoided From The Start:

Mistakes in medical insurance billing can be frustrating. Health care providers depend on their reputation. When coding and billing mistakes occur they will lead to complications, frustrations and often serious complaints. Needless to say, medical coding and billing mistakes are best avoided from happening in the first place!

Confusing and indecipherable bills

Failure to follow consistent billing cycle

Failure to credit payments

Failure to deduct payments from balance owed

Failure to obtain pre-approval or pre-certification

Failure to obtain supplemental or spouse insurance information

Finance charges on billing mistakes/improper finance charges

Improper filing of insurance/failure to file insurance

Denial of care due to outstanding balance, even when balance is in dispute

Denial of care to patients with "pre-paid" coverage, such as HMO members

Denial of care to children of parents with outstanding balances

Demanding payment in full from patients with previous bankruptcy filed against provider, even when patient has current health coverage; otherwise denying treatment

Excessive rates for services; fees above "usual and customary" for many insurance companies

Resurrecting old medical bills, from as long ago as 16 years

Forcing consumers with outstanding balances to get treatment at facilities in other counties

Read: When Hardball Tactics Go Too Far

Failure to honor payment agreements made with patients

Unwillingness to put payment agreements in writing

Improper notification to consumers that their accounts have been "flagged" for no service

Refused requests for information and/or clarification of bills

Charges for goods or services never received

Bills sent to inappropriate address or person

Finance charges to Medicare patients

Pushing consumers to use credit cards or take out bank loans in order to pay medical bills in full

Charging HMO members improperly by calculating members' 20% co-pay based on the standard price, rather than on the HMO's discounted price

Not understanding how patients reach their deductible and what portion of the payment goes to the deductible

Having an outdated patient insurance card on file

Overcharges, double-billing

Coercive and intimidating collection practices by Patient Accounts representative

Upcoding—billing for more complicated procedure than was performed

Read: Upcoding Fines

Diligent Follow-up

Upon discovering improper payments, billing mistakes, or alleged misconduct, all pending issues must be addressed as competently and as quickly as possible. The sooner these issues are dealt with and resolved, the better, to avoid unnecessary (further) reimbursement delays, or possible practical, possible legal issues.

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Benefits of Medical Billing and Coding Certification... Countless job seekers face barriers to employment and promotion because they lack professional credentials! Certified professionals are more readily hired at higher pay than their non-certified counterparts. Since 1989 over 150,000 health care professionals have earned the recognition and rewards gained from passing NHA certification exams. By attaining certification they have joined a growing distinguished group of knowledgeable and expert health care professionals. NHA grants Certified Billing and Coding Specialist credentials to: new graduates based on their training working individuals based on experience through NHA's Home Study Program		Reasons Behind the High Demand For Medical Billers Medical, therapeutic, and pharmaceutical services play an important role in our nation's economy! Driven by the ever increasing need for medical services wherever there are people the opportunities in healthcare related disciplines never cease to exist. There is plenty of room for men and women in healthcare occupations as long as they have the drive to achieve their dreams. Employment is not limited by location, gender, race, religion, or even disability. Recruiters and employers are readily hiring qualified staff to better serve their patients and clients; this includes medical billers, whose job it is to make sure healthcare providers get paid for the medical services they have provided in their community.