Filing claims is complicated business. Over the years I've seen many clinics make the mistake of not appreciating the technical skills for being good at filing claims and collecting money. I explain to them that filing the claim is just a starting point in a lengthy process which involves following the money to be sure it is collected and taking action if it isn't. And in a very large percentage of cases, additional action is required to get the money.
Filing a claim is a necessary but insufficient condition for getting paid. It just starts the ball rolling. If that's all a provider does, the chance of making enough money to keep the doors open is pretty much nil.
I see providers hire high school kids with no experience and expect them to run a collections operation for them. They're lost in a sea of "codes" -- CPT codes, Diagnosis codes, diagnosis "pointers", modifiers, place of service codes, provider numbers for the billing provider, the facility, the referring provider, the attending provider, relationship codes, accident indicators, you-name-it.
If the biller knows exactly what they're doing it is often difficult to get claims paid. Put one in there who doesn't know what's going on and it is a recipe for disaster. |
