As a follow-up to my latest article, "Educating Patients on Healthcare Benefits," I want to shift gears a bit and share my perspective as a billing manager and consultant on where the billing department's responsibilities should lie. Here are scenarios where it is not the billing department's fault or responsibility if something goes wrong during the revenue cycle:
• Coordination of benefits: If you don't tell us about your other insurance plans, we can't bill them. If you do not call your plan and let them know who is primary and who is secondary, both will pay as primary — and then we are left with a mess to clean up.
• If you have a deductible or coinsurance that the front office will be collecting, they collect based upon how the provider codes. If they collect incorrectly, it is not billing's fault. Don't blame us.
• When your insurance plan quotes us benefits, and we collect according to their instructions, don't get mad at the billing department if we process your claim differently. Call your insurance company and yell at them.
• Your plan may have some exclusions on specific benefits or body parts. If those exclusions are not provided at the time of verification, that's on your insurance plan for not divulging that information. When we bill you for the services rendered, do not yell at us, call your insurance company and ask if they would reconsider paying the claim. If not, it's up to you to pay the provider.
• When you purchased your insurance plan, it's up to you, the consumer, to review the plan benefits. It would be like buying a car without knowing if it had power steering, air conditioning, or a stereo. You need to review all of the details of your plan — if you don't understand it, call your insurance company and have an educated representative go over it with you.
• If the provider is out of network with your plan, there is most likely a reason. It's probably because of poor reimbursement from your plan. On rare occasions, a similar provider in your area is already on that plan, and the insurance company feels that is adequate in serving their customers. It's not because the provider did something wrong and is not worthy of being in your plan's network.
• Don't blame your billing department if the plan has assessed a cost share to you. This could be in the form of a copay, coinsurance, or deductible. Welcome to healthcare, it's expensive.