The nature of health care billing requires workflow efficiency, and any mistakes made in the billing or accounts receivable process could have a drastic impact on the relationship between an organization and its patient.
A recent article in the Chicago Tribune featured a story about Diane Caldwell, who last December visited her local health care provider for routine blood work. In January, she received a bill for $961.25 and when she called her insurance company she was told the claim was denied and she was responsible to pay in full.
It turns out the blood work was incorrectly coded as not medically necessary, so the insurance company would not cover it. After several attempts to contact her health care provider and her insurance provider, Caldwell was no closer to resolving the issue. She even attempted to pay the hospital $240 because she figured paying a partial amount would move the process along.
"I assumed I had to pay part of it," she told the Tribune.
Unfortunately, the payment was incorrectly processed. Shortly after the check had cleared with her bank, she received a bill asking for the initial amount and when she called to ask about the missing money, she received no straight answer. Finally, she was contacted by someone who told her the right coding had been submitted, the amount was cleared and she owed nothing. While there was still the matter of the missing $240, Caldwell was happy to know her bill was resolved.
That's when a collections agency contacted her demanding a payment of $961.25.
Caldwell again made several angry calls to the health care provider and insurance company and eventually learned that the claim was not fully processed until the collections letter went out. It took several attempts, but she finally figured this out and was able to ignore the collections letter, but this solution did not resolve the matter of her missing $240 payment.
According to the Tribune, she did not hear back after several attempts to contact the hospital. She even faxed a copy of the check and received no response. She contacted "What's Your Problem?" — an organization affiliated with the news source — that was able to help her receive a refund on the lost check. All is now resolved, and the hospital was apologetic about Caldwell's poor experience, but it's undetermined if the relationship between her and the health care organization is severed beyond repair.
While this is largely a series of extenuating circumstances, it does speak to the importance of having organized and efficient accounts receivable management. It's likely that this case was a matter of inefficient operations, which can be mitigated by working with the right professionals.
An organization that assists with clearing outstanding accounts receivable issues can allow you to focus on more important accounts, while ensuring you do not get overwhelmed. This will alleviate the risk of issues such as this happening to your department.