I am a recovering biller.
Posted By: CrankyBeach on 2009-09-23
In Reply to: Tired of the MT paycuts; wondering how hard it is to go to billing or file clerk or something!! nm - frustrated
I have also done the file clerk/medical records thing.
The filing job is fairly mindless and stupefyingly boring. Do NOT try it without an I-pod or some such device. It will save what little sanity you may have left.
Billing is a different story. The money was great--but it cost me far too much. Here's how it works, as briefly as I can describe it.
You call up the patient's insurance company to find out whether the provider you work for is allowed to see this patient in the first place (i.e. are you in or out of network) and does the patient's policy require you to get authorization to see the patient, and perform any necessary tests.
So, having gotten all your authorization ducks in a row (or so you think), you see the patient, post the charge(s) and send in a claim, and you get paid. Right? Wrooonnnnng!!!
First, if it's a new patient to your practice, the insurance company will demand medical records practically back to the patient's birth, trying to find that all-important pre-existing condition, so they can deny payment on those grounds. You of course HAVE no medical records because it's a new patient.
If you get past that hurdle, then they'll try and claim you needed authorization and you didn't get it. Well, yes you did--but it takes more time and more phone calls and faxes back and forth to prove you did have auth.
Now they've somehow lost the original claim at their end, would you please resubmit it.
This person is not one of their insured members. Oh, yes they are. More phone calls and faxes, plus trips to the insurance company website to verify and print out eligibility information on the patient so you can prove it.
The proper form was not attached; this requires a HCFA 1500. Attached to their 'the proper from was not attached' form letter is... you guessed it... the very HCFA 1500 claim form they are claiming was not attached.
The head-shaped dent in your wall gets bigger.
Meanwhile, your doctor want to see the patient again, so you call again and go through the authorization hokey-pokey all over again, because even though you didn't need authorization last week, they change the rules every time they take a breath, so you might just need auth this week.
Then they want justification for the CT scan you just ordered. (Ummm... how about to see whether the cancer treatment is actually working before we dump more poison into the patient's veins??)
So then the medical director at the insurance company gets hold of the file, and mind you, he's an 89-year-old retired pediatrician who hasn't actually had his hands on a real patient since 1969 and wouldn't know a standard-of-care treatment regimen if it bit him in the ankle... so then you have to go to the online medical library to download all and print out all the various studies that show this treatment is indeed standard-of-care, not to mention the press release from the FDA showing that this particular treatment regimen is approved for the indication you're giving it for....
And that's all before lunch.
No, I am not exaggerating. All of those things--and more--happened to me on a quite regular basis.
Yes, I took a massive pay cut when I came home to transcribe full time, but oddly enough I have never been tempted to go back....
Complete Discussion Below:  marks the location of current message within thread
The messages you are viewing
are archived/old.
To view latest messages and participate in discussions, select
the boards given in left menu
Other related messages found in our database
I agree. As medical insurance biller/coder/transcriptionist
I agree with the other poster. You're better off going with a group plan than on your own. Largely, because you pay the same premiums across the board as everyone else on your plan. When your on your own individual plan, I was scared to use my or have a new diagnosis because come renewal time, your premiums are adapt to go up staggering and there is nothing to can do about it, other than drop them and then you are in a worst situation. Yes, group insurance premiums usually go up every year but it's nothing like what will happen to if your on your own. Also, you do get a contracted adjustment based on your insurance's contracted allowable rate. Say your visit is $100 and the contracted rate/allowable through the insurance is $75, that means the doctor has to write off that $25 according to their contract.
|
