The world of insurance billing can be a crazy place. But there is a way through, so let’s talk about it. You’ve been billing a procedure the same way all along. One day the insurance company pays it – the next day they don’t. The EOBs aren’t clear. You correct a claim in a way that makes sense, though that doesn’t result in payment. Your associate down the street had the same problem, but his fix doesn’t work for you. Regulations change, and insurance companies change their rules. Billing can feel like you’re in a maze with the walls moving all the time.
If you don’t get on top of it, your accounts receivable just grows and grows. Insurance companies are often not forthcoming with the information you need. It’s not helpful, but it saves them money because so many practices don’t persist through the confusion. Here lies the difference between a “really good biller” and the rest.
Recently, I spent half a day getting to the bottom of a workers’ comp claim denial – the insurance company was no help. The sources I found online were contradicting. Finally I reached a friendly supervisor at the state Workers’ Compensation Division who took the time to look things up for me and offered to help get the insurance company to clean up its act. I have used those answers over and over again for that client and for other clients as well. It took time, but those were hours well spent!
I’m in many chat rooms and billing groups online. Billing professionals post questions and other billers try to help or make suggestions. It’s not an exaggeration to say that many of the answers I see in those groups are wrong. I know because I spent the hours on the research to get the right answer, and my client’s claims are getting paid.
Here’s the information I pass on to other billers when I have the chance:
Logic doesn’t necessarily apply! Most of the billers I have ever come across are rational people who simply may not have realized that the answer to most of their billing confusion isn’t going to be what seems to make the most sense. Whether something should be a certain way, or whether something isn’t fair just doesn’t matter. Not knowing the answer already does not make you any less of a professional biller – because the answers change all the time. The trick that’s going to result in increasing payments is simply finding out what IS, rather than acting on on what SHOULD BE.
Knowing that it simply IS confusing but there ARE correct answers to be found goes a long way toward making your way through the maze. When there’s a confusion, find out what the correct source is for the information you’re looking for and go there. You can get to the bottom of it, with some persistence. If a piece of information doesn’t seem right, or contradicts something else you know, keep asking questions. If one insurance rep can’t – or won’t – answer the question, “What does that mean?” call again and get a different rep! It can take some tenacity. It may be the insurance company, but it could be the Medicare Local Coverage Determination. It may be the clearinghouse, or the code books or your software tech support. Follow the path with whatever the correct source is for the info you need, and follow it until you have an answer that works. We at Orion Billing have years of experience on the phones with insurance companies. But most importantly, we have a lot of push and follow-through. We care enough to find out where things are going wrong and why, and we stay on top of the collections to make sure you get paid. We have been successful in wading through the maze the insurance industry presents, and we actually enjoy solving these puzzles for our clients every day. Call me and let’s talk about your billing. I’d love to find out how we can help you!
Kat Jordan is the Owner of Orion Billing Services, a professional external billing company. With extensive experience in healthcare billing, Orion is well prepared to help with thorough, knowledgeable claims submission, follow-up and collection.
Call (415) 851-1605 for more information.
Comments are closed.