Medical Billing Disputes: Finding Peace between Patients and Billers

Your front-office staff is great. They check patients in, smile, schedule, and do everything right. The doctor or nurse sees the patient, listening intently for any clue that might help them solve whatever the problem. The patient leaves happy.

Then the bill arrives. The patient has a coinsurance they need to pay, and are very willing to do so, but it appears something has gone wrong with the insurance payment amount. They call the number on the statement to pay the bill, and get a not-so-friendly customer service representative. Things go downhill from there. A month later, the patient comes back into the office beside themselves, acting like a lunatic waving a bill around. Once you bring them into a private room away from the rest of your patients, you find out the problem: The patient has been fighting with your billing company for over a month to get a better understanding of what has happened.

This scenario happens far too many times. The office provides excellent service and the billing department - not so much. What is a practice manager to do? First, try to identify the actual problem and go from there.

Here are some tips on conflict resolution between your practice, the patient, and the billing department.

1. Identify the person in the billing department who the patient has been dealing with. Find out the rest of the story, as it could be the patient only had one interaction with the billing department, and the employee could have been trying to explain that the bill was part of the patient deductible and coinsurance. When patients don't want to hear what they don't understand, they start to argue.

2. Once you have a clear understanding of the problem, find out where the customer service portion of the patient experience failed. If it was lack of follow up with the patient or if the representative was indeed rude, that should be addressed with the billing department's manager.

3. Take this opportunity to create a plan with the billing manager to address overall customer service opportunities within the department and how you would like a very specific level of customer service to your patients.

This should include:

• Friendly customer service representatives for your patients.

• If the patient is not satisfied with the level of service, they should be allowed to speak with the manager immediately.

• Follow up with patients. If the representative says, "Let me call you back on that," a phone call best be made within a specific time frame; in most cases 24 hours in a good rule of thumb.

• If your office is unsure how an insurance is going to pay a claim and the patient needs to be seen multiple times for similar treatments, it is reasonable to ask the billing department to follow a claim from beginning to end. They can then call and let your office know if the insurance is imposing a copay, coinsurance, or deductible for the patient to pay. Your office can then inform the patient. Good billing departments can get most claims through to the major payers in less than two weeks.

Overall, the billing department is part of your team. They need to be on-board with your requests and policies. If you find there is a lack in this area, it's time to set up a meeting and set some standards for them. You are their customer and should be treated as such.