Medical Claims Assistance

The paperwork is voluminous and in this profession, a Ph.D. stands for Piled High and Deep, which is usually the state bills are in before we are called.  Welcome to the world of modern healthcare in the United States.  To think of this as controlled chaos may actually be an undeserving compliment but medical billing is here to stay and will only get more complicated as live expectancies increase.

As a claims assistance professional, we navigate through the abyss of paperwork and light the fire under the insurance companies and medical billing providers to resolve billing issues and keep the collection agencies in the loop and off your back working hard to resolve billing issues.  In short, we act as your advocate and interpret the paperwork and uncover the underlying problems.

Some of the thing we do is fighting the screw-ups that appear on medical billing paperwork.  This includes double billing, misbilling, and errors that have reached epidemic proportions in this country.  Recent estimates show that insurers reject 4.5 billion claims per year, roughly three out of every ten filed with insurance companies.

When insurance companies fight over who is primary provider and who is tertiary, the only one who loses out is the recipient and the medical providers.  But the recipient is placed right in the middle of this battle due to HIPAA regulations. 

Most clients are happy to hand off this burden to us.  They feel like the weight of the world (and of the papers) has been lifted off their shoulders.  Historically speaking, there are errors with 80% of all inpatient hospital stays, due to a number of reasons.  The common denominator is the coding that has been established within the industry (called HIPAA codes), which are prone to interpretation and dispute.  The same procedure can be billed 3 different ways depending upon the forms completed by the healthcare individual. 

Then, when bills sit around for an extended period of time, which can easily occur when the bill payer is sick or tending to the needs of the loved one that is, the claims start to fall into the collections.  Once a bill goes into collection, the medical provider has washed its hands of it and is not inclined to help with information that might resolve the dispute.

As facilitator to the billing process, we get involved with all parties and work towards the common goal of resolving and disposing of the issues.  Simply paying a bill to make it go away may sound like the right choice, but with the costs of care rising at least 5% a year, no doubt this will be a high price to pay.