• Doctors pop in to ask questions, address concerns, or discuss issues relating to a patient-billing problem.
• The office manager tells us a patient has called them to complain about something we did or didn’t do
• The office manager asks us to run a report for a meeting
• The front desk tells us a patient is here without a referral and wants to be seen anyway
• The front desk asks us to come and calm down an irate patient
• Calling insurance companies to discuss specific billing issues

Dealing With Irate Patients
Many times, the medical biller is asked to handle the irate patients. Since we do it on and off all day long on the phone, we have the experience and willingness to handle these difficult patients. We have the skill, knowledge, and customer service ability to handle the irate patients.

But it does take its toll on the billing person’s day and the level of stress.

Dealing With Patients and Insurance Companies
Billers have to call insurance companies and argue with them about paying the claims, and we have to explain to patient’s why they owe what they owe.

We have to explain over and over again the rules of the practice and rules in general related to HIPAA, and that we can’t just “write off” the final amount all of the time.

A Specific Test
Maybe there is a test that the doctor wants to do and the patient at the time said to go ahead with the test even though they were warned their insurance may not cover it. The patient wants to do whatever the doctor thinks may help their problem.

Then 60-90 days later, the bill from the insurance company comes to the patient. The patient sees the amount due, sees the insurance company will not pay that specific test as they see it was not medically necessary. The patient picks up the phone, calls the doctors billing department and he is upset.

The patient has forgotten that he was warned this specific test might not be covered. He says “Well the test only took 15 minutes, I don’t know why I should pay $150 for it. If my insurance didn’t pay it, it must be because you coded it wrong, if you would just code it right, I sure they will pay for it. My insurance says to fix the code and to send it again and then they will process it.”

But we know that most likely this recent claim will be denied as duplicate. We can’t just change codes because the insurance carrier says if we do that they will cover it. We must use the appropriate codes for that visit which we get from the physician and the chart.

If the claim does get sent to the insurance company for the second time, it is best if the patient mails it to them directly. They have more power than they realize, the billing staff just needs to explain this to the patient. Most patients won’t mind mailing in the information if it means they will not be responsible for paying the bill.

Avoiding Rejections
The best way to avoid rejections is collecting the proper demographics on the patient and insurance data. Making sure all the data is entering accurately.

• Have a fee slip/encounter form that allows the doctor to select specified codes and/or to hand write the diagnosis if not on the page.
• Have the modifiers on the fee slip/encounter form to make it easier for the doctor to note the circumstances if he/she understands modifiers. If they don’t, they need to learn in order to save/make more money.
• Have your staff call ahead and verified the patient’s insurance coverage, checking for any preexisting clause, whether or not they have met their deductible. Doing this the day or two days before saves you from problems at the last minute, opens up slots for paying patients.

My Top 5 Rules for Proper Billing

1. Never use unspecified codes
2. Never code from the index of the coding book
3. Never guess, if you don’t know find out for sure the correct answer
4. There are NO BILLING EMERGENCIES; therefore there is no reason to guess because you are rushing. It is best to wait and get the correct answer before sending out the claim.
5. Purchase current ICD-9 and CPT coding books

About EYE Bill FOR YOU

Based in Virginia with 54 years of combined experience and a broad range of medical billing knowledge, EYE Bill For You offers HIPAA compliant medical billing for many specialties. Our medical billing outsourcing solution is offered in the Virginia, Washington DC and Maryland areas.

Cathy Boddie (owner) has an established reputation for helping doctors lower their accounts receivables by examining super-bills and improving them to increase reimbursement levels. Cathy has taught students in medical billing and coding at Northern Virginia Community. Cathy has provided lectures and training sessions on medical billing and coding, Self Pay Issues, and working with Embassies accounts at Georgetown University Hospital and Medical Center.

http://www.eyebillforyou.com

EYE BILL FOR YOU
Cathy Boddie, Owner
email: cathy@eyebillforyou.com
phone: 877-EYE-BILL or 877-393-2455

For permission to republish the above article, please contact Cathy Boddie.