Medical Bill Auditing

Medical bill auditing can save a patient a significant amount on hospital bills by finding and identifying bogus charges. Many companies that offer this service charge the patient based upon a percentage of what is deducted and the total amount owed must be above the minimum amount the company is willing to handle. Hospital bill auditing includes going over every charge itemized with a fine tooth comb to make sure that the charges are legitimate. In most cases the service company will need a complete copy of the patient's medical records and an itemized bill from the hospital. Questionable charges are researched extensively. Since the invoice is going to be disputed it is better if the patient has not started paying on it until after the service company reconciles it.

Service companies who scrutinize invoices on medical charges do not normally charge the customer a fee unless they are able to get some of the charges deducted from the invoice. They do not normally deal with insurance covered charges and if they did any amount of money saved would go to the insurance company not the customer or patient. Medical bill auditing is normally very successful in disputing charges because oftentimes there are errors on itemized invoices. The charges that are legitimate will need to be paid on while the disputed items do not have to be paid as long as they are being investigated. "O send out Thy light and Thy truth: let them lead me; let them bring me unto Thy holy hill, and to Thy tabernacles" (Psalm 43:3).

The usual charges on an invoice are ancillary items, room and board, and routine items. Ancillary is virtually anything other than room and board or routine items. These might include medications and solutions as well as services from other departments such as radiology, cardiology, pathology, and so on. Hospital bill auditing takes into consideration that some of the charges are proprietary and are set amounts that are controlled by the owners. Charges for room and board may be based upon the area the facility is located in and the overall expenses that are incurred. The facilities that have fewer expenses can usually charge lower fees for room and board.

One thing that does have to be taken into consideration for care and treatment is that a physician may have ordered a specific type of service or treatment when an alternative treatment might have been cheaper. This type of dispute has nothing to do with the hospital but instead is between the patient and the physician. Usually physicians are private practitioner's and do not work for the facility. With this being the case, medical bill auditing services will not dispute itemizations based upon what a physician orders unless there are other considerations involved.

A common way that errors can occur with billing is when test or services are ordered for a patient but then the patient never receives them because the physician changes the order. An overworked billing department may not catch this type of error. However, if the patient's medical records are used and research is done then hospital bill auditing may easily find these types of occurrences. A patient needs to be aware of what he or she is actually receiving. This includes services, medications, tests, procedures, and supplies. If possible the patient should keep records of anything that the hospital supplies even down to receiving an aspirin.

Some of the common errors on medical invoices include erroneous overcharges, charges for medications that the patient never received, charges for tests that were never done, and charges for personal and routine supplies the patient never used. With these types of errors the medical bill auditing company will need to go over each charge with the patient to make sure that everything listed on an itemized invoice is correct. Other types of errors may include data entry errors, the wrong medical codes for procedures, charges for repeat tests that had to be done because the technician goofed up but the patient was charged for both, and charges for services that should have been included with a room charge.

Medical records are a vital part of checking an invoice for errors. Hospital bill auditing services include the expertise of comparing the invoice with the complete medical records of the patient. Many companies that offer this type of service include a report of findings based upon the medical records in correlation to the charges billed. When the records show that the patient received a specific amount of a medication or a solution but the invoice reveals something different then this is a legitimate discrepancy. This type of error is more easily corrected than other common types of disputes because there is something in writing to back up the claim that being the patient's records.

A patient will have more success in disputing an invoice that is recent. Waiting a long time to use medical bill auditing services could make a difference on how successful the outcome is. In addition, if the invoice has been paid in full and then gets serviced for disputes the company who handles it will probably charge an hourly fee to the patient because there will be greater difficulty in successful outcomes regarding discrepancies. The patient must sign a contract with the service company before they will begin the auditing process. After the service company audits the invoice they will submit their findings to the hospital. The facility will have up to 90 days to resolve any disputed issues or they may lose the right to collect.

Medical Receivable Factoring

Some healthcare providers turn to medical receivable factoring as a way to create cash flow during the time between when treatment is given to a patient and the insurance company pays the invoice. For a doctor, having one's own practice entails much more than seeing patients and doling out medical advice. A doctor's office has the same concerns that any other type of business would; there are employees who need to have steady, consistent paychecks, and utility and overhead bills that must be paid in order to keep the practice operational. Sometimes, staying on top of these many different financial obligations can be taxing, especially if the practice is relatively new or is financially struggling. For these reasons, many doctors choose to align themselves with a medical receivable factoring company in order to keep their business and practice solvent.

The term medical receivable factoring can be confusing for those not already familiar with the concept. The process, however, is a relatively simple one to understand. Someone in the medical field, whether a doctor, physical therapist, paramedic, etc., can, if they own their own business, choose to sell the open invoices to a factoring company in order to get cash quickly. The only invoices that are generally eligible to be traded in this fashion are open ones that need a third-party's payment in order to be considered closed. This would mean that after a patient pays his portion of the bill, whether that is a percentage of the total or a set co-pay, then the remaining balance will be paid by whatever insurance company the patient has. The factoring company will advance money based on the total amount of the invoices, and the doctor's office would continue the collection process as normal. When the money is finally paid, however, the funds will go to the company rather than the practice. This gives the doctor the ability to use the money before the insurance company actually pays it, without having to worry about repayment or interest, such as with a loan.

It is important to understand what factors can affect the fees that a healthcare practice has to pay once agreeing to a contract with a medical receivable factoring company. Generally, a company will decide how much to charge a practice based on the amount of open invoices transferred at any given time and the average time that it takes to collect. For example, invoices that are not due for three to four months will automatically require higher fees than ones that may be coming due in several weeks or a couple of months. Most companies will advance the practice a standard percent on each batch of invoices sent to the company. This percentage is generally agreed upon before business even commences and usually does not fluctuate. Once the insurance or third party company makes the remaining payments on the balances due to the invoices, then the factoring company will pay the practice the remaining percentage due. This, of course, never equals the total amount of the invoices because the company has to take out its fee.

Since most agreements between a healthcare provider and a medical receivable factoring company are for an extended period of time, a person needs to make sure that they are well acquainted with the factoring company's reputation. Any time that money is exchanging hands, especially on a continual basis, a relationship of some sort is created. And a doctor or other medical professional will do well to make certain that he does not enter into any type of relationship that he may regret later. Many factoring companies see themselves as "silent partners" in the practice. This can be a good thing, of course, because the advancing of cash in lieu of open invoices fulfills a definite need for the practice. On the other hand, the partnership could sour quickly if a person aligns himself with a company that is unscrupulous and less than honest about what they expect from the doctor.

So what is the best way to make sure that the healthcare provider is going to be partnering with a legitimate medical receivable factoring company? The first step is to check out the company thoroughly; doctors should ask around, checking with their colleagues to see if anyone has had any experiences, good or bad, with the company. Secondly, the practice should make sure to check with government agencies such as the Better Business Bureau to see if any record of the factoring company is listed. Between these two options, a doctor should have a pretty clear indication of what his peers, and others who have used the company, thought and whether the endeavor is worth pursuing. The healthcare provider also needs to be sure to read the contract thoroughly before signing anything. Oftentimes, disreputable companies will try to sneak hidden fees and charges into the contract, hoping that the customer will not notice until too late. Any legitimate company will be completely honest about any fees and assessment charges that the provider may have to pay, and a reputable company should not hesitate to answer any questions the practice may have before signing the contract.

Many practices choose medical receivable factoring as a way to secure immediate access to money that will be paid eventually without having to take out a loan. Often borrowing money can have many negative drawbacks and can cause much grief for the borrower. If possible, finding other avenues to generate cash flow is advisable as even the Bible cautions against falling into debt. "For the Lord thy God blesseth thee, as he promised thee: and thou shalt lend unto many nations, but thou shalt not borrow; and thou shalt reign over many nations, but they shall not reign over thee" (Deuteronomy 15:6). Choosing medical receivable factoring can be, if done wisely and cautiously, the best way to keep a struggling practice afloat or to bolster a new doctor's business until the finances are stable and secure.







Copyright© 1996-2014 ChristiaNet®. All Rights Reserved. Terms