Blame the insurance company is the mantra exclaimed by all, but does it really fit. I know they can give us a fit when trying to collect our money, but they really want to pay the provider, they just want the provider to play by their rules.

I know I will get a lot of grief by saying that they really want to pay the provider, but hear me out. The reason they want to pay is because they want more clients to insure. If they did not pay the providers, the providers as a group would stop seeing their patients, the patients would then not be able to utilize the coverage they are purchasing and would begin to flounder about looking for other coverage. The insurance companies do not want that! Now granted, the insurance company wants to keep as much money as possible, but they know, sooner or later they are going to have to pay the piper! It is a self balancing system that when left alone will right itself each and every time.

This subject came up last week because I was talking to a new provider about his billing. I had previously discussed his billing and he said he wanted to continue for a while with what he was doing. He acknowledged that all of his claims were not being paid and many of the rejections had to do with the billing staff. Sadly, he has now stopped seeing one entire group of patients that are associated with one of the CMOs handling part of the Georgia Medicaid program. This really hurts my heart, because of several reasons, not the least of which is the patient. They are currently locked into that CMO and cannot change, want to see this particular provider, but now are unable to do so. The added pain is that it his medical billing that is at issue and not the insurance company. You see, the billing personnel have convinced him that the insurance company is at fault with why they are not being paid. Nothing could be further from the truth!

My staff handle numerous claims that go through that company and those claims are getting paid. It is not magic, it is good old fashioned hard work of keeping up with what the payer wants, and passing that information through in the form of a claim. Day in and day out they are paid.

Do not allow your staff to point the finger at that unknown faceless giant called the insurance company when the billing staff does not do their job in getting your claims paid. Force them to take an active role in getting each and every claim paid! Do not allow them to get away with sitting back and blaming someone else. Working medical billing is an ongoing learning experience and anyone who is not willing to continue to learn and keep up should be moved out.



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