New Marketing Offer

     Medical billing services are often looking for new accounts and new ways to market their services.  We offer three ebooks on marketing to help these business owners find new opportunities.  So we are always looking for new opportunities to teach to our readers.  This week we got a call from a company who asked if we were interested in getting government contracts for medical billing.  We weren’t sure if it was something we would be interested in or not but thought we should learn about it to offer the information to our readers.  We got the basic info and made an appointment for a fifteen minute phone call to hear the details.  Here is what we found.

This was a private company that offered the service of completing the hundreds of pages of application necessary for the government to offer you jobs.  Contracts were granted for 5 years with the opportunity to renew 3 times for 5 year periods.   The company would keep your applications up to date and renewed for 20 years.  They guaranteed you would get work or our money was refunded.  We were asked if we could promise to take on 2 new accounts in a six month period.  We were told that we didn’t need to bid on these jobs.  As a preferred provider the government and some city or county owned organizations were required to utilize preferred vendors.  When medical billing services were required they would get a list with your name at the top and you would get the job.  You could charge between 8% to 13%.  Their charge was $5500.00 for their service.

They also told us that there was only one GSA preferred provider in New York State and they were in the NYC area.  There was a great need for medical billing providers and this one company couldn’t fulfill all the needs.  We asked if we were limited to the NYS area and were told no, they could put us on the national list.

Red flags went up at some of the things we were told.  Some things just didn’t make sense.  The man we were speaking with happened to mention the name of the one preferred provider in NY so we told him we would think about it and he could call back on Friday.  We “googled” the name he mentioned of the other service and sent an email inquiring about the GSA contract.  A few minutes later we got back an email saying don’t do it.  It’s a scam.  She spent $8000 and got nothing in jobs and no inquiries.  She also said that she had to bid for the work and that there was only one instance in 18 months that she could bid on and she didn’t get the bid.  So beware of this tactic.  It may have worked out for some and we would love to hear about anyone else’s experiences.   If you have had any experience with this type of work please share your information.  We can all help each other.

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Secret of Reversing a Denied Insurance Claim

Medical insurance claim denials can be very costly to the medical office and to a billing service. Denied claims must be investigated to see why they were denied and what must be done for the provider to be reimbursed for the service. Some denials are legitimate. The services may simply not be covered under the patient’s insurance plan. Many are in error or may be due to an issue that can be corrected and then reprocessed by the insurance carrier. If an insurance claim is denied but you believe it should have been paid there is one secret to the successful resolution of that claim. That secret is…

Persistence

It may take as many as six resubmissions and/or up to eight phone calls as we recently experienced but you must stay on top of it to get final resolution. One of our favorite providers saw a patient for several counseling sessions and the claims came back denied stating the patient had no coverage with that plan. We reported this information to our provider who then checked with the patient. The patient called United Healthcare and straightened out the coverage issue. The provider called us back and advised us that the issue was resolved and asked us to resubmit all of the visits. All claims were resubmitted but three weeks later another denial arrived still stating the patient had no coverage.  After speaking to a customer service representative we were told that the patient is still not a member of that plan. We explained that the patient had called and straightened out this issue.   After a lengthy hold, the customer service representative returned and advised us that the patient did indeed have coverage. We were told to resubmit the claims again.

After not hearing on these claims for another month we called back and were told the claims were now denied due to the CPT code. They stated that the provider was not authorized to bill for the extended visits. However the provider did have the appropriate authorization. The customer service representative advised us that the claims would be sent back for reprocessing. We heard nothing for another month and called back to find that the claims were not put back through for reprocessing. Three weeks later we called back and were told that they were still being reprocessed. A month later we received a denial stating the claims were denied by the Medicare system.

We called back and explained that these were not Medicare claims and should not have gone through the Medicare system. The representative offered to send them back for review. A month later we called back to find that they no longer have a record of the claims with the appropriate id number. They asked us to fax them in. Faxed, called, verified receipt! A month later we got paid for 2 of the six claims. I would like to say that it was finally resolved, but we are still waiting for payment on the final four claims which of course we called back on once more.

Obviously we will not recoup all the expense of this lost time in tracking these claims. But this is work that must be done. It all averages out in the end. The bottom line is that it may be necessary to follow up multiple times on problem claims. If this is not done much money can be lost. Hopefully you never run into one this involved.

If you are having issues with denied claims and do not know how to get the best results, check out our ebook “Denials, Adjustments and Appeals”