Dealing with a Difficult Provider – Part 1

February 16, 2010 — solutionsmedicalbilling

One of the things you don’t realize yet when you first start your medical billing business is how different each provider will be from the next. You will need to learn the differences and how to deal with the difficult ones.

Some providers are very easy to work with and some can be very difficult. When you don’t yet have any experience it can be difficult to decide how to handle the problems that arise.

One of the problems medical billing services run into is the doctor’s office that doesn’t send over enough information. It may be that the initial claims lack info or that they fail to send you all the payments. We have experienced providers who fail to tell us about patient payments that have been made and we send a bill for services that have already been paid.

Each of these individual issues is a problem for both the biller and the provider. When the provider’s office sends over claims to be submitted with dates of birth missing or no insurance information, that claim cannot be submitted. This causes a delay in payment for the provider. For the billing service it causes a bunch of problems. First, the biller must notify the provider that they are lacking critical information. Second, the biller must keep this claim available so when they get the necessary information they can complete the claim and submit it. If this is a common problem for an office, you may find that after a few months you have a fat file folder of claims waiting for information that never came. Neither you or the doctor will be paid for these claims until you get the information.

When providers don’t send you notice of all the payments you will find that when you are working your followup reports and checking claims status many of these claims will have been paid. The problem with this is that a biller can’t be wasting their time calling on claims that have been paid. It’s funny that this is usually the same provider who will be calling you demanding to know where all their payments are. It’s difficult for you to tell because you spent 6 hours making phone calls on a 28 page report that should have been a six page report if you could have entered the payments as they actually came in. Now you’ve spent an extra four hours finding out the provider was paid last month. The other problem is that you don’t have the eobs if any of the claims have a secondary payor, you can’t submit them without a copy of that primary eob. Of course there probably were some legitimate problem claims that required attention but you are so frustrated with finding that all these payments were made but not sent to you that you really don’t care at that point. Yes, there were problem claims, but the provider made you look through a mountain of claims instead of the small pile that really had problems. These providers suck up extra time that you may not have allowed for when you originally quoted them a price.

When providers forget to let you know that patients have made a payment and you send them out a bill for that service they already paid for, the patient tends to get mad. This is not good. Not only do you have an angry patient calling you but you wasted money sending out that statement.

So what’s the answer to these problems? Good question. Usually you need to sit down with the provider and explain why this is not a good situation. I must warn you, many do not want to hear about it. Some providers do not want to know what is going on. We explain to our providers that when they don’t send us the eobs it takes us much more work to call to get the information and we have to charge them more. This usually helps the situation. We also explain that we can’t submit the secondary claims without the primary eobs.

Again, you can talk until you are blue in the face and it won’t change things in some offices. That’s when you have to make the decision if this is an acceptable situation to you or if you feel you must cancel your contract with that provider. Sometimes it is just easier to move on and let that client go.