Tuesday, September 2, 2014

It’s Not Just to Provider

billingAnother experience, simple treatment in office for poison ivy – my nemesis! Called my PCP and was told he could not see me but there is a new mid-level provider available later that day if it would be OK to see her. Of course that would be fine. The experience was typical – arrive at the office, hand over the credit card, wait 20 minutes and then escorted to the exam room. Treatment was as expected, a steroid shot, prescription and on my way home.

About a month later we receive a statement indicating we owed ~$190 for a level 4 office visit and that the insurance company had denied payment due to provider not part of the network. We called, staff indicated they  were aware and that the claim would be re-billed under that doctors name since credentialing had not been completed for the new mid-level. They would also look into the documentation for the appropriate level of care, they know that I am a consultant and understand the process.

Another month passes and we receive another statement for the same amount due! We checked our insurance companies web site – which we had done before as well – and noted that the claim had not be re-billed. We called, talked to a new billing clerk and were told not to worry about it, it was the billing services fault and they would take care of things.

A couple weeks later we noted the claim still had not been re-billed. It is now over 90-days since the office visit, we have not received a third statement but know that the claim is still outstanding. I also know that I there should be a payment processed for the injection (out of pocket expense not paid for!). Is there a timely filing issue here?

Key points:
  • On-board new providers thoroughly including their credentialing, inform all staff members as to how to bill properly, discuss proper coding and documentation
  • Do not blame anyone, e.g., the billing service, instead be proactive to correct the situation and call the patient back with the status instead of leaving things hanging.
We have discussed whether or not to continue to see this provider (other instances such as delays in returning phone calls, etc.) who is fine as a doctor but the office just doesn’t have its act together.

What impact the support process has on your patient care and expectation is critical for you’re on going success.

photo credit: via photopin cc

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