Sample Contracts Don’t Work

I know we have written on this many times, but it can’t be said often enough…….  If you are a billing service, make sure you have a good contract!  Even having the best contract in the world does not mean you will never have an unpleasant situation but having a good contract will help you avoid many unpleasant situations and help you navigate through the ones that cannot be avoided.  We see posts on our forum all the time about difficult situations that billing services find themselves in.  Having a well written contract that covers all of the issues helps to prevent, or handle many of these situations.  Recently we had a post by someone in an unexpected predicament with one of his providers.  It is very recent so we still don’t know the outcome but here is what he wrote:

“I had a client for 2 years that never complained and as far as I knew things went along splendidly. I would go to his office at least 1x a week at his request because he was close and it made him happy. I’m a outsourced billing service. In June he decided he wanted me to work in the office. I declined because I have other clients & that would change our contract. I worked hard in June to change his mind. Until he kept insisting that I work in his office so I had to tell him NO. On June 19 he cut my access to his billing software. At this point he already owed me for May. I met with him a few times to try and resolve the issues he had. I told him he had to give me a 30 day notice in writing as per our contract. He said he would give me 30 days but I had to serve them in his office. Which I could not do. I said I would come 2 or 3 days and send my employee’s in but that was not good enough. It was me or nothing. So after 3 letters from my attorney he paid me for May. But refuses to pay me anything for my billing in June. Remind you he cut my access and gave me notice June 19th. Which would mean he owed me a % until July 19 if I had gotten my 30 days notice. He says he is not paying me b/c I did not come into the office to work. My contract is simple and I am sure I could win this in court. He owes me at least $4500. Now that I have my May check the advice I need is do I risk him bad mouthing my all over town for $4500. Maybe he won’t but maybe he will. Maybe it would make no difference. I have other clients. But I was just getting my foot in the door locally. Maybe he will bad mouth me anyway. He has it in is head I billed wrong. But I didn’t. I have it in my head he was just having a really good month in june and didn’t want to pay me my %. ADVICE? ”

We don’t know what his contract specifies, but in a case like he is describing a good contract is crucial.  There is really no good outcome that can be expected but with a good contract at least he has a better chance to be reimbursed some of what he is do.

Tips for a good contract:

•    DON’T copy someone else’s!  You need to write your contract for your needs
•    Consider everything that can come up or go wrong and write what you would want done to handle it
•    Make sure there is a specific way to terminate the contract from either end and spell out what situations that can occur

For more information on contracts see our book “Write a Kick Butt Contract for Your Medical Billing Service”

Michele Redmond
Vice President

Solutions Medical Billing Inc
1-800-490-4299  ext. 101
1-315-207-4222  ext. 101
Fax:  315-865-6359

Denied Insurance Claims – Tip Series 1

Denied insurance claims seem to be one of the areas that many medical offices struggle with.  They either do not have the time to deal with them, or they don’t know what to do with them.  In any case, denied insurance claims can cause much loss of revenue.  If not handled and not handled properly, the provider can lose out on income that is due to him.  We are starting a series of tips on handling denied insurance claims.  Our first tip is on making sure that all claims affected by a denial are corrected and resubmitted.

Tip #1:  Make sure All Claims Affected are Corrected and Resubmitted:

One thing that tends to get overlooked when handling denials is to check for other outstanding claims on a patient when a denial is received that will affect all claims out on a patient.  For example, if a denial is received for a patient because the patient’s insurance has changed then all claims submitted for that patient after the change of insurance will need to be corrected.

Many times a biller will receive a denial for one particular date of service, make the correction and resubmit just that one claim.  They don’t take the time to look and see if there are any other claims out for the patient that also need correcting.  As I’m writing this I’m thinking it would be a no brainer, but in all of my years of training this is actually something that needs to be taught especially with new or inexperienced billers.  They just don’t think about the whole picture without being taught to.

It is not uncommon for us to be checking over the work of a newer or inexperienced employee to find that they were informed of an insurance change on a patient.  The information that they received was for one specific date of service.  They corrected that one claim and resubmitted.  What they didn’t do was to look at the patient’s file to notice that there were several other dates of service out there also submitted with the incorrect insurance information.  Those claims also need to be corrected and resubmitted.

We also teach them to look at the other family members as well.  If the insurance changed for one of the children and the policy is through the parent, it most likely changed for everybody in the family.  Looking into it now can save much work later on and even prevent money from being lost.

If the denial is for something that is only specifically related to the claim in question then this is not an issue.  But if the denial is for something that would affect all claims for the patient and/or family, then it is important that the biller take the time to make sure all claims are corrected and resubmitted and not just the one that received the denial.

Issues that may affect multiple claims for a patient:

•    Change of insurance carrier
•    Change of insurance ID number (Blue Cross Blue Shield often changes ID numbers!)
•    Truncated or invalid ICD code (this can affect multiple claims for specialties such as mental health, PT, chiropractic and others)
•    Invalid patient information such as date of birth or misspelled name

For more information on Handling Denials see our online course:  “Reading EOBs, Handling Denials and Filing Appeals”