"Clean" claims, access to care, praising Congress
I enjoyed the article by David M. Jaspan, DO ["Clean up your claims," August 15, 2008]. As a self-employed billing service and managed-care consultant, I have often found myself between the insurance company and the doctor. While it is true that some plans are more doctor-friendly than others, it is also true that the insurance companies are not always the worst enemy we have.
I continuously stress to my clients that they are the first ones touching the superbill, charge slip, routing slip, and encounter form. The cleaner it is-and the more advanced it is in using modifiers and trying some add-on codes that are clearly described in a CPT book/computer program-the better the chance to see an improved cash flow.
I also try to stress that correct is better than quick, having seen my share of superbills that are sloppy and incomplete in the doctor's haste to get them out the door to me for billing. In addition, a review of outstanding claims every month will yield results before claims get too old and the insurance company issues that dreaded code: timely filing denial!
After 14 years in this business, relying on a salary based on the doctor's receipts, I have no choice but to employ strict policies for myself, as well as the offices with whom I have enjoyed long-term relationships. And when you have to call insurers as much as I do, it helps to know what you're talking about.
Failure to execute the billing and collection part of practice management is emblematic of faculty practices, in our experience. Behind it: an attitude of detachment from the urgency of the issue by program heads and the bureaucracies they command, the faculty who are more interested in teaching and research, and residents with their own unique set of preoccupations. What is astounding in Dr. Jaspan's account is that the powers that governed the process actually considered firing obstetricians as a solution to a temporary cash crisis. You fire the coach, not the players.
JEFFREY J. DENNING
La Jolla, California
YET ANOTHER STALL TACTIC
Thanks for the article on insurance stall techniques and what to do ["How to get paid," August 15, 2008]. However, the latest technique doesn't even get to the issue of repeatedly denied claims because many of our claims are allegedly not being received by certain insurance carriers. This is the latest stall technique-to insist that the claims never reached the insurance company, regardless of whether they were sent by online programs, by fax, or by mail. We actually have a number of claims that apparently aren't being received for consideration. What can we do about this repeated stall tactic? There is nothing wrong with our software because the process appears to be very random, affecting only a certain number of claims, and yet no problems with others.
SYDNEY CRACKOWER, MD