Academy of Chiropractic Personal Injury & Primary Spine Care Program

Quickie Consult 326

From the Desk of Dr. Mark Studin
Academy of Chiropractic
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time.

"Billing Companies, Insurance Staff, Partners, Bosses Can Be Great...BUT...Could Cost You Your License"

Billing Verification is Critical

 

I just got my "umpteenth" phone call from a doctor who abdicated his billing to a third party only to find out that the billing was quite creative. This doctor from upstate New York had a billing company that billed for services not rendered. Then they disappeared, stealing the receivables and leaving the "clueless" doctor responsible for all bogus bills rendered. The carriers, using their metrics, realized the doctor did not perform the ICD's billed, forwarded the case to the local district attorney's office and arrested the doctor for insurance fraud. At the end of the day, the doctor had to close his office, didn't get paid from any other carriers as they all were alerted and never recovered the money stolen. However, the doctor had $50,000 in legal fees in order to unravel the improper billing mess.

IF...the doctor asked for a spreadsheet with all dates, charges, ICD-9 and CPT codes prior to being billed for review, this never would have happened.

Another doctor in the south shared office space with another provider who performed the billing of both as part of the shared space agreement. The billing doctor didn't know the correct codes  for chiropractic, so he picked incorrect CPT codes because he'd had experience in getting paid with massage codes. The treating doctor got paid, but never looked at the HCFA's that went out or the electronic claims submitted. One year later, the doctor changed staff and saw, for the first time, what had happened.

My advice is that this doctor should do a forensic analysis for the entire time frame and see the difference between what was billed and what was paid. Then he should hire a health care lawyer to negotiate on his behalf with the proviso that he might have to re-pay the carrier 100% and start the billing process for what was done. The reality is that he is also beyond the statutory allowable billing time and the carrier will demand a 100% refund.

IF...the doctor asked for a spreadsheet with all dates, charges, ICD-9 and CPT codes prior to being billed for review, this never would have happened.

Another doctor worked for a mid-level sized practice and never saw the claims. The owner (aka Greedy Bastard) billed for many services never performed and was retrospectively audited. The associate doctor had to hire a lawyer to defend his notes or at least the ones that were in his handwriting and not someone else's. This cost him $25,000 in legal fees. The alternative was jail.

IF...the doctor asked for a spreadsheet with all dates, charges, ICD-9 and CPT codes prior to being billed for review, this never would have happened.

My office, 15 years ago, got a hold of invoices for durable medical equipment that was to be paid at 150% of invoice by a greedy salesperson that delivered the supplies. I never looked at the invoices given to us, I only paid the ones mailed to me. After 6 months, my accountant did an analysis of the practice and saw an addition $23,000 in income from supports.  After changing my shorts a few times that day, I called my lawyer and wrote $23,000 in checks as a refund and $5,000 to my lawyer. I then didn't sleep for months because other doctors I know who did the same thing, with the exception of the refunds, were all indicted. At the end of the day, I lost $4,000 in income and $5,000 in legal fees with LOTS of sleep.

IF...the schmuck (me) asked for a spreadsheet with all dates, charges, ICD-9 and CPT codes prior to being billed for review, this never would have happened.

The moral of the story, no matter who does your billing, whether it's in-house or through a service, always request (demand) a billing report to review all charges and codes prior to submitting billing for services rendered by you. If your name is at the bottom of the HCFA (paper or electronic), you are personally responsible for what is billed.

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