How Late Payments, Patients can Throw off a Medical Biller's Day

November 5, 2013

Little things can add up, as this glimpse into a day in the life of a medical biller reveals.

Dear Diary, even though it’s Monday, today started out with much promise of being a good day. The end of month collection percentage totals for last month looked great. The percentage of money in the over-120-day-and-aging bucket was down to 0.2 percent and the overall amount due on the accounts receivable report was down by $32,000. I had high hopes that the day would end as well as it began.

My first task of the day was to review the schedule to see which of today’s patients had a past due balance. Finding four such patients, I began to review their history and send necessary alerts to the receptionist. The first two patients had balances from surgeries and were making regular monthly payments as promised. So far so good. The third patient had owed a balance for almost two months and had not yet set up a payment plan, even though he had been back for a recheck appointment just last week. That’s where my hopes for the day began to sag a bit.

The fourth patient had been the victim of a car accident and one of our doctors had been called from the emergency room to do surgery. The hospital had not given us any insurance information on this patient, so I looked to see what information the patient had given at his first recheck appointment in our office. Nothing was written in the section for insurance. Great. As I read through the note history, I found a note from the receptionist that said, "At checkout, asked patient to pay on surgery balance. Patient responded that the accident was the other guy’s fault and that’s who would have to pay the bill." Further notes revealed his adamancy that he was not going to pay this surgery balance. We were at an impasse because our doctor was on main ER call that day and we were required to continue seeing him until treatment was complete. At this point, my hopes for the day were swinging mighty low.

I called the car insurance claims adjustor only to be told that the hospital bills had exhausted the MedPay limits on the patient’s automobile policy and the at-fault driver did not have car insurance. The patient’s attorney had already been in contact with them about a settlement but in all reality, it would probably end up going to court. The adjustor said that if a settlement was reached, it would be paid to the patient who would be responsible for using it to pay the remainder of his medical bills.

I added my note to the history and inserted a pop-up note that I needed to speak with the patient when he arrived. Judging by the previous encounter our staff had with him, I was not looking forward to his arrival at 10:30.

The next order of business on the “to do list” was to check status of pre-certs that had been requested last week. I called ABC insurance company first because three of the precertifications were theirs. I don’t know how so much changes in one week at insurance company, but apparently it can. I dialed the same number I had called the week prior to begin the precert process. After going through the maze of prompts, a person answered who informed me that I had reached the wrong department. I assured her I had chosen all prompts carefully. She asked for the number I had dialed originally. I told her 800-000-0000. She said that was the problem; that number was not for precerts at all. She agreed to transfer me to the correct department. The person in that department would have loved to help me, but they don’t handle precerts for that employer group. Again, I was transferred to the correct department. Four transfers later, I finally connected with a representative who said that if I had just dialed 800-000-0000 I would have reached her directly and avoided all of this unnecessary frustration. I’m glad she couldn’t see my expression through the phone.

Confident that I had at last reached the right person, I gave her the patients' information for whom I had requested precertifications. Two were in process she said, but the third request was not on file.

"Why not?" I demanded to know. I had sent all three sets of clinical information and photographs in the same envelope. If two were there, what happened to the third one, I wanted to know. The rep suggested that maybe I had forgotten to include the third one. I knew I had put all three in there. After 20 minutes of back and forth and being put on hold so she could check with other departments, she finally came back to the line to let me know it was found in the mail room. She informed me that I would have to send the photographs again because she was not able to locate them.

At this point, I gave up all hope for the day ending on a good note and I was pretty sure this was a good indication of how my week was going to be. It was also at this point that I wondered if other billers really faced the same frustrations as me. I also contemplated whether or not billers should automatically have a prescription of Prozac. Like some people have a jar of peppermints on their desk, maybe billers need a little jar of happy pills.

Signed,

A frustrated biller