OPTION-1 STEP-1 Medical billing is an extremely important component of the healthcare industry. Doctors and other medical professionals spend many, many years of studying, practising and preparing for a future in the healthcare industry. They face all kinds of challenges everyday from providing life-saving emergency treatment, to researching difficult diseases. Medical billing is a critical component of a successful medical practice. In today’s world one of the biggest challenges physicians face is not patient care, but the business side of healthcare. Especially the billing and coding side.
Physicians leave an estimated $125 billion dollars on the table each year due to poor billing practices. 2 of the most common factors contributing to the loss in profits are: Billing Errors- up to 80% of medical bills contains errors. Since insurance companies are so strict on correctly billing and coding a claim, even the smallest mistake can be the reason an insurance company rejects a claim. Then the doctor has to fix the error and resubmit the claim all the while hoping the insurance company will reimburse them for their services. This could take several months or more before the doctor receives payment.
Failure to stay up-to-date on medical billing rules and regulations- the rules for medical billing are constantly changing, which causes physicians and administrators to spend time and money on keeping their staff trained and up-to-date on the changes, which eats into the cash flow and profits of a practice. STEP-2 The people most affected by medical billing mistakes are: Physicians, who lose money from billing mistakes that go into the millions and even billions of dollars. Insurance Companies, the insurance companies lose millions of dollars each year, because of insurance fraud.
Patients, the patients are affected by the billing mistakes because their claim might have the wrong code or the medical biller mistakenly said the procedure was covered by the patients insurance when it wasn’t and the patient ends up having to pay out-of-pocket. STEP-3 A) The physicians are interested in the medical billing aspect of their business because that is the source of their income.
Without correct billing the physician either has at least one of three things happen, 1) They don’t get paid if the wrong code is submitted and until the right code is submitted they have no revenue coming in for that patient. 2) Their medical biller submits the wrong code that causes the physician to be underpaid for services. 3) Their medical biller submits the wrong code that causes the physician to be overpaid, which might result in the physician getting into trouble and having to reimburse the insurance company. So physicians want an office staff that is up-to-date on their different jobs in the practice and they would especially like for the medical biller to be up-to-date on all the changes that are being implemented in the healthcare industry when it comes to being reimbursed for services.
In other words keep a steady cash flow coming in and not a lot of it going out. B) Insurance companies are interested in the medical billing part of healthcare because in today’s world you see too many stories of doctors who file false medical claims and receive million and millions of dollars for work not done, claims for fictitious patients, work done that was not needed and many, many more examples of false claims. There are too many to name them all so I just chose a few.
Insurance companies are paying out billions of dollars in false claims and they would like for the fraud abuse to stop and for there to be an easier way to detect the fraud abuse. C) The patients interest in medical billing mistakes is that they want the right codes on their claims that are submitted so that they don’t have to pay out-of-pocket for a procedure when their insurance would pay for it. Most patients don’t want to be told that their insurance covers all costs of a procedure then the patient ends up getting a huge bill because their surgery wasn’t covered.
If the patient was billed for a procedure that wasn’t covered by their insurance and it was the ors office that made the mistake, then the patient shouldn’t be the one who has to bear the brunt of the mistake. The patient just wants the billing done right the first time so that they won’t have to go through a long process of correcting what was obviously the medical billers mistake. STEP-4 A) Dr. Kaveh Safavi said, “all involved in medical billing want to minimize billing mistakes”. He also gave five suggestions, which were for preventing medical mistakes.
They are, “be sure your provider has accurate up-to-date information on you, understand your insurance coverage, keep track of what services you have received and what you’ve paid and keep records, when you receive an Explanation of Benefits form from your insurer, don’t just toss it in the trash or file it away, and finally don’t just pay a bill because you received one”. Dr. Safavi is very much against medical billing mistakes, these mistakes make it harder for everyone involved in the process of healthcare. B) Insurance companies are the number one companies that are against medical billing mistakes.
Medical billing mistakes cost the insurance companies billions of dollars and in order to fix a mistake it takes a lot of manpower and hours, just to find one little mistake on a claim. There are many different reasons for the mistakes whether it’s duplicate bills, canceled tests or procedures that was still put on the claim, upcoding charges, and even unbundling of charges. Those are all mistakes that must be corrected which takes time to do. The insurance companies would like the claims to be done right the first time so that they can be processed and reimbursement made in a timely manner.
If the claim is wrong it could take several months to fix before reimbursement is made. By looking for some of the most common errors on medical bills, you can protect yourself from potentially paying thousands of dollars in unnecessary costs. C) Avon resident Anita Harris stated that, “it is a very helpless feeling”, when she fought the Cleveland Clinic for over eight months about a bill for more than $6,000 dollars in charges for tests her husband had after mentioning heart palpitations and leg cramps during a routine physical. “a lot of people would just throw in the towel and pay the bill, because it’s not worth the hassle”, she said.
The Harris’ insurance company denied their claim because of a medical billing mistake. The mistake was eventually corrected, but it took dozens of phone calls, letters, and email messages. It was so much extra work that Anita Harris called it her part-time job. “it’s very frustrating”, Tim Harris said, “Healthcare is the only industry that you don’t know what it’s going to cost until it’s done”. Sol would say that the Harris’ are against medical billing mistakes because they cost you time, sometimes extra money and they are a big headache to get corrected. STEP-5 Twould say that each group has a valid argument on medical billing mistakes.
The mistakes cost a lot of people a lot of time, energy, and manpower to find and fix one little mistake that if the medical biller had taken the time to go back over the claim form before submitting it, then their would be a lot less hassle and headache for everyone. Some medical billing mistakes have even caused some families to lose their homes and life savings. Which should never have happened, if the biller would be careful with how they fill the claim forms out in the first place. The doctors lose revenue, the insurance companies lose money, and the patient loses money because of these mistakes.