Are Your Billing Errors Costing Your Patients‪?‬ Revenue Cycle Decoded

Transcript:

Are Your Billing Mistakes Costing Your Patients Money?

Hi, everyone, welcome back to Revenue Cycle Decoded where we are cracking the code on revenue cycle issues. Today, I just wanted to riff a little bit on a topic that kind of chaps my hide a little bit, and that topic is billing errors that are costing your patients money or time.

So, let’s get started with this topic. The reason that I wanted to talk about this topic today is that I just received a bill from my dentist. Of course, dentists are not fun in the first place, at least not usually, but getting a bill is even more not fun. You want to be billed accurately from your dentist, and unfortunately, this bill was not accurate. So let me tell you a little about it.

I went to the dentist and had a cleaning and received the bill. I’m in network. My health plan is in network, the dentist is in network with my plan, I should say, and so they submitted the claim to the health plan. The EOB came back to the dentist with a denial for one of the services that was billed for the reason it cannot be billed on the same day as another service that they also billed for.

So, lets’ break that down. If there is an administrative denial on a claim because two services can’t be billed together on the same date of service – that's an administrative denial – you can’t then go and balance bill your patient for that according to your contracts with your payors. Unless, you know, it’s something that is not normally covered by the payor and you’ve received the patient consent to cover that, that’s a different story. You have to explain to the patient that this is a service that isn’t normally covered by the payor and therefore if the patient wants it to be performed, then they would be responsible to pay for it; they sign a consent stating that they are going to be responsible for that service and then you can balance bill the patient. But in this case, it was an administrative denial, the reason being that the code itself – the HCPCS code – specifically states that it cannot be billed with the other service on the same date of service. It’s the intent of the code.

So, they had seen the denial on the EOB but they had added back the portion for the denied service onto my patient responsibility and sent me a statement for that amount. Now because I am a certified coder and a certified biller, I immediately questioned, “why am I being billed for a service that was denied?” I looked up the codes so I understood exactly what I was being billed for, and I also looked up their professional association guidelines from the American Dental Association and found that there is indeed a specific guidelines for these two codes which states that because of the code definition of one of the codes, they cannot be billed together on the same date of service and it recommended other codes that can be billed for an exam, for example. Then, I also contacted my payer to make sure that this was an administrative denial and that I was correct that the dentist cannot bill.

So, the good news is, I did call my dentist and talked to their front office person who will forward my concern to her manager, but interestingly, when I discussed the issue with the claim, she stated, “We’ve never had somebody bring this up before.” Now that gives me a bit of a pause because that tells me they may be routinely billing these two codes together and patients who are not certified coders and certified billers may not understand the reason that they are getting balance billed and they may just be paying the bill. In other words, they may be paying something that they really, legitimately don’t owe and the fact is that the office is incorrectly billing them and it’s costing the patients money, or at the very least, time, as it did me, to look up the error and inform the office of the error.

Hopefully, the next statement that I get, the error has been corrected and the amount