Last week I wrote about the newly popular view that medical billing specialists are frequently being presented in the online media as villains and crooks.  It was inspired by the article “Don’t let medical billers cheat you” at philly.com, written by Paula L. Stillman, MD, MBA. 

In Part 1, I provided a logical explanation for a likely honest reason the patient had been billed by their provider:  the office simply did not have full or accurate secondary payer information.  This happens in practices all the time.  See full article here.

A common office staff error can also cause a payer to not be billed.  This scenario happens when either the entry of the policies was done incorrectly or in the case of multiple payers, payment information from the primary payer was not entered correctly to generate the secondary claim.

When physician billing software, like Iridium Suite, is able to auto-adjudicate data from electronic remittance advices, there is a reduction in those types of payment keying errors.  Patient accounts that accurately indicate the hierarchy of payer responsibility, will generate the secondary and even tertiary claims appropriately.  This avoids the patients receiving those balance bills in error.

In the anecdote provided in the above mentioned article, I agree that the patient was not treated appropriately by the standards of courtesy I know most providers desire in their practice.  I always suggest patients that have had a billing misunderstanding with a member of the office staff bring it to the attention of the practice manager or the provider.  Often they have no idea this type of behavior is happening and it will likely be corrected.

See this article “Don’t Let Patient Billing Ruin Your Good Rep” for hints on keeping your patients trust in your office billing practices.

I do not live in a fantasy world of just rainbows and unicorns.  I know that there are those who do participate in some unscrupulous billing practices, but the general public should be aware, it represents a very small proportion of the medical claims processed.  The best way to ensure you are not cheated, is to be an informed “medical consumer”.  This means understanding your benefits and comparing bills to the explanations of payments you receive from you insurance.  More often than not, it has just been an honest mistake or lack of proper billing staff training.