Medical Billers Must Avoid Reimbursement Denials
When billing problems occur they will lead to complications, frustrations, and often serious complaints. This is not acceptable and most be avoided when ever possible.
Billing problems are best avoided from the beginning! The means a strategy is needed before you ever start billing.
The following are a few examples of typical medical billing and collections problems that can occur as a result of oversight and error, or sometimes incompetence. Many physicians, particularly Internists, are concerned about reimbursement for concurrent care when they see a patient in consultation on the same day as another internal medicine specialist or subspecialties.
List of Common Problems:
medical coding Confusing and indecipherable bills
medical coding Failure to follow consistent billing cycle, as stated in provider’s policy
medical coding Failure to credit payments
medical coding Failure to deduct payments from balance owed
medical coding Finance charges on billing mistakes/improper finance charges
medical coding Improper filing of insurance/failure to file insurance
medical coding Denial of care due to outstanding balance, even when balance is in dispute
medical coding Denial of care to patients with “pre-paid” coverage, such as HMO members
medical coding Denial of care to children of parents with outstanding balances
medical coding Demanding payment in full from patients with previous bankruptcy filed against provider, even when patient has current health coverage; otherwise denying treatment
medical coding Resurrecting old medical bills, from as long ago as 16 years
medical coding Excessive rates for services; fees above “usual and customary” for many insurance companies
medical coding Coercive and intimidating collection practices by Patient Accounts representatives
medical coding Failure to honor payment agreements made with patients
medical coding Unwillingness to put payment agreements in writing
medical coding Improper notification to consumers that their accounts have been “flagged” for no service
medical coding Refused requests for information and/or clarification of bills
medical coding Overcharges/double-billing
medical coding Charges for goods or services never received
medical coding Upcoding — billing for more complicated procedure than was performed
medical coding Bills sent to inappropriate address or person
medical coding Finance charges to Medicare patients
medical coding Forcing patients with outstanding balances to get treatment at facilities in other counties
medical coding Pushing patients to use credit cards or take out bank loans to pay medical bills in full immediately
medical coding Charging HMO members improperly by calculating members’ 20% co-pay based on the original full price, rather than on the HMO’s discounted price
medical coding Not understanding how patients reach their deductible and what portion of the payment goes to the deductible
