REAL CASE STUDIES

Summary

A small clinic hired front desk person to do the billing as they were told by their chiropractic patient software company it was an easy process. In a short time, clinic had $100,000 in unpaid claims and lost $50,000.

Advocate Insurance Billing (KRB) had a small clinic that we did insurance billing for. They terminated our services as they felt that billing was a simple process in their software that their front desk staff could handle. They had been told by their chiropractic software company that it is such a simple process for them to do each week.

Last year we got an email from them explaining that they now had over $100,000 in unpaid claims and that they didn’t know why. They thought that it should be going smoothly and everything getting paid, but it wasn’t. So they hired us for a Billing Review and Audit Service. We went into their system and did a thorough review of their unpaid claims and presented them with a 15 page report of the reasons for the denials. 

One of the many reasons we discovered for unpaid claims was because of incorrect or unallowable diagnosis codes given. The doctors did not know what the allowable diagnosis codes were (the ones allowable by Medicare etc.) and so most of their claims were being denied. When KRB had been doing the billing for them, we reviewed over all the claims BEFORE they went out to ensure that allowable diagnosis codes are being used. If there were incorrect codes being used, we emailed the doctor and asked him to fix it before we billed it out. We provided guidelines for the doctor on what are allowable/payable codes.

“They ‘saved’ by not paying a professional insurance billing company, but then lost $50,000.”

 

After this clinic terminated our services, the staff member who handled the billing just hit the “batch claims” buttons each week in their software and sent them to the clearinghouse. The staff member didn’t know to check the diagnosis codes used, didn’t know to check the condition date, didn’t know to put in the alerts in certain accounts to let the doctor know that they had used up the number of allowed visits for that diagnosis, etc.

It is a simple process to create the batched file of claims to submit to the clearinghouse. Any staff employee can quickly learn how to do that in your software. But it is all the billing experience in preparing the accounts for billing that is our greatest service to clients. We work hand in hand with the doctors to ensure that their claims get paid.

So after 2 years of not utilizing our services, they had $100,000 in unpaid claims. The oldest year of claims we couldn’t rebill because they were past timely filing limits. They were all lost and so the clinic lost $50,000 because they didn’t want to pay for our services that year. They “saved” by not paying a professional insurance billing company, but then lost $50,000 (a fraction of which they would have paid us.). It doesn’t make good business sense.

This clinic now has us handling their ongoing billing again and we are excited to help them achieve stability in their billing process. A happy ending!

Summary

A clinic was spending about $400/month on clearinghouse charges. We discovered this in our review/audit of their in-house billing. We showed them that this was completely unnecessary and guided them on how to avoid these charges.

Can a clinic lose money with unnecessary charges in the whole billing process? Does it happen? YES!

One thing that comes to mind quickly is clearinghouse charges. We’ve had providers tell us that they aren’t spending much each month on clearinghouse charges…only between $80-$100 per month. Well that might not sound like much, but it is a totally unnecessary expense for a clinic. 

One of our clients owns multiple clinics and they were spending approximately $400 per month minimum for their clinics for clearinghouse charges and it was all unnecessary charges. Their software company sold them this service telling them that it would save them so much time in billing. Because of inexperience in this area they bought into that and ended up spending thousands of dollars on a service that saved their clinics maybe one minute of time each time they did billing.

“We have helped many clients to eliminate or greatly reduce their clearinghouse charges each month…”

You don’t need to pay anything for clearinghouse charges each month, or if you do it only needs to be a small amount. We have helped many clients to eliminate or greatly reduce their clearinghouse charges each month by just signing up for the right service. It’s just knowing the right questions to ask and to know to sift through the sales pitches from the software company.

Summary

Clinic tried for almost a year to get set up with Medicare. Finally gave up and called us.

One of our current clients had been trying to enroll in Medicare for almost a year since it was a new clinic. They had multiple enrollments submitted to Medicare and denied. The doctor got so frustrated and rightly so and made statements like, “Medicare is so hard to work with. We should just stay out of Medicare.” This clinic then hired Advocate Insurance Billing to handle the Medicare enrollment issue.

As we dove into the situation, we discovered a lot of interesting information. Medicare kept denying the applications for multiple reasons, but the biggest reason was because the legal name of the entity registered with the IRS did not match the legal name listed on the clinic’s bank account. We discovered that the Entity was initially set up incorrectly by the attorney. The attorney registered the clinic with the IRS as a specific name, but then added the word “The” when he registered the clinic with the State.

You would initially think that this is not a big deal but this had so many repercussions. When the bank account was set up for the clinic, the bank follows the name that the company is registered as with the state. So the word “the” was in the name on the bank account and so the checks for the bank account had the word “the” in the name. When I began collecting the information needed to complete the initial Medicare enrollment application for the clinic, two of the things that Medicare requires is a copy of the IRS letter 147 C which shows the legal name of the entity with the Tax ID, and they also require a copy of a voided bank check to set up electronic funds transfer.

But the legal name of the entity on the IRS letter 147 C and the legal name of the entity on the bank check did not match. Medicare automatically denies an enrollment application if those 2 items do not match.

So to be able to get the clinic enrolled in Medicare, multiple things had to be done. We couldn’t just call the bank and say “please give us new checks without the word ‘the’ on it” because the bank will only make the name of the account what the State says is the legal entity name. So we had to call the State Department of Financial Institutions and make an amendment to the Articles of Organization to legally change the name of the entity to get rid of the word “the” in the entity. Then once we received the Amended Articles from the state, we were able to give those to the bank for them to legally change the name of the bank account. Then they were able to provide us with new checks with the corrected legal name on them. We also had to correct the name with the State Department of Workforce Development and the State Department of Revenue.

“The doctor got so frustrated and rightly so and made statements like, “Medicare is so hard to work with. We should just stay out of Medicare.”

After all of that, we were finally ready to submit our initial Medicare enrollment application because we now had our IRS letter 147 C which matched with our voided bank check.

But because it took so long to get the Medicare application sent in to Medicare, we had to prepare what is called a Medicare Reconsideration Request.

Medicare only gives a clinic an effective date of 30 days prior to the Medicare application being received by Medicare. Because it took months to make all of those name changes, during which the clinic had been treating Medicare patients, we really needed the effective date to be back dated. So we prepared a Medicare Reconsideration Request for the clinic to submit to Medicare requesting Medicare to give the clinic a back dated effective date, so that the clinic could still bill all of those dates of service to Medicare.

Also, because no one at the clinic had noticed or knew to pay attention to the entity name issue, when they set up the clinic billing info in their chiropractic software, ChiroTouch, they set up the clinic with the name “the” in it. They had been billing to all of the other insurance companies with the name “the” in it. So we had to go into ChiroTouch and set up their clinic billing set up correctly for Medicare. And then fix their demographics with the other insurance companies that they had been sending claims to with the wrong name.

This is one example of lots of issues to fix all because things weren’t set up the right way at the beginning. This is just one example of how important it is to set up everything correctly to avoid headaches.

Summary

A small clinic hired front desk person to do the billing as they were told by their chiropractic patient software company it was an easy process. In a short time, clinic had $100,000 in unpaid claims and lost $50,000.

KRB had a small clinic that we did insurance billing for. They terminated our services as they felt that billing was a simple process in their software that their front desk staff could handle. They had been told by their chiropractic software company that it is such a simple process for them to do each week.

Last year we got an email from them explaining that they now had over $100,000 in unpaid claims and that they didn’t know why. They thought that it should be going smoothly and everything getting paid, but it wasn’t. So they hired us for a Billing Review and Audit Service. We went into their system and did a thorough review of their unpaid claims and presented them with a 15 page report of the reasons for the denials.

“They ‘saved’ by not paying a professional insurance billing company, but then lost $50,000.”


One of the many reasons we discovered for unpaid claims was because of incorrect or unallowable diagnosis codes given. The doctors did not know what the allowable diagnosis codes were (the ones allowable by Medicare etc.) and so most of their claims were being denied. When Advocate Insurance Billing had been doing the billing for them, we reviewed over all the claims BEFORE they went out to ensure that allowable diagnosis codes are being used. If there were incorrect codes being used, we emailed the doctor and asked him to fix it before we billed it out. We provided guidelines for the doctor on what are allowable/payable codes.

After this clinic terminated our services, the staff member who handled the billing just hit the “batch claims” buttons each week in their software and sent them to the clearinghouse. The staff member didn’t know to check the diagnosis codes used, didn’t know to check the condition date, didn’t know to put in the alerts in certain accounts to let the doctor know that they had used up the number of allowed visits for that diagnosis, etc.

It is a simple process to create the batched file of claims to submit to the clearinghouse. Any staff employee can quickly learn how to do that in your software. But it is all the billing experience in preparing the accounts for billing that is our greatest service to clients. We work hand in hand with the doctors to ensure that their claims get paid.

So after 2 years of not utilizing our services, they had $100,000 in unpaid claims. The oldest year of claims we couldn’t rebill because they were past timely filing limits. They were all lost and so the clinic lost $50,000 because they didn’t want to pay for our services that year. They “saved” by not paying a professional insurance billing company, but then lost $50,000 (a fraction of which they would have paid us.). It doesn’t make good business sense.

This clinic now has us handling their ongoing billing again and we are excited to help them achieve stability in their billing process. A happy ending!

Summary

A clinic was spending about $400/month on clearinghouse charges. We discovered this in our review/audit of their in-house billing. We showed them that this was completely unnecessary and guided them on how to avoid these charges.

Can a clinic lose money with unnecessary charges in the whole billing process? Does it happen? YES!

One thing that comes to mind quickly is clearinghouse charges. We’ve had providers tell us that they aren’t spending much each month on clearinghouse charges…only between $80-$100 per month. Well that might not sound like much, but it is a totally unnecessary expense for a clinic.

One of our clients owns multiple clinics and they were spending approximately $400 per month minimum for their clinics for clearinghouse charges and it was all unnecessary charges. Their software company sold them this service telling them that it would save them so much time in billing. Because of inexperience in this area they bought into that and ended up spending thousands of dollars on a service that saved their clinics maybe one minute of time each time they did billing.

“We have helped many clients to eliminate or greatly reduce their clearinghouse charges each month…”


You don’t need to pay anything for clearinghouse charges each month, or if you do it only needs to be a small amount. We have helped many clients to eliminate or greatly reduce their clearinghouse charges each month by just signing up for the right service. It’s just knowing the right questions to ask and to know to sift through the sales pitches from the software company.

Summary

Clinic tried for almost a year to get set up with Medicare. Finally gave up and called us.

One of our current clients had been trying to enroll in Medicare for almost a year since it was a new clinic. They had multiple enrollments submitted to Medicare and denied. The doctor got so frustrated and rightly so and made statements like, “Medicare is so hard to work with. We should just stay out of Medicare.” This clinic then hired Advocate Insurance Billing to handle the Medicare enrollment issue.

As we dove into the situation, we discovered a lot of interesting information. Medicare kept denying the applications for multiple reasons, but the biggest reason was because the legal name of the entity registered with the IRS did not match the legal name listed on the clinic’s bank account. We discovered that the Entity was initially set up incorrectly by the attorney. The attorney registered the clinic with the IRS as a specific name, but then added the word “The” when he registered the clinic with the State.

You would initially think that this is not a big deal but this had so many repercussions. When the bank account was set up for the clinic, the bank follows the name that the company is registered as with the state. So the word “the” was in the name on the bank account and so the checks for the bank account had the word “the” in the name. When I began collecting the information needed to complete the initial Medicare enrollment application for the clinic, two of the things that Medicare requires is a copy of the IRS letter 147 C which shows the legal name of the entity with the Tax ID, and they also require a copy of a voided bank check to set up electronic funds transfer.

But the legal name of the entity on the IRS letter 147 C and the legal name of the entity on the bank check did not match. Medicare automatically denies an enrollment application if those 2 items do not match.

So to be able to get the clinic enrolled in Medicare, multiple things had to be done. We couldn’t just call the bank and say “please give us new checks without the word ‘the’ on it” because the bank will only make the name of the account what the State says is the legal entity name. So we had to call the State Department of Financial Institutions and make an amendment to the Articles of Organization to legally change the name of the entity to get rid of the word “the” in the entity. Then once we received the Amended Articles from the state, we were able to give those to the bank for them to legally change the name of the bank account. Then they were able to provide us with new checks with the corrected legal name on them. We also had to correct the name with the State Department of Workforce Development and the State Department of Revenue.

“The doctor got so frustrated and rightly so and made statements like, “Medicare is so hard to work with. We should just stay out of Medicare.”


After all of that, we were finally ready to submit our initial Medicare enrollment application because we now had our IRS letter 147 C which matched with our voided bank check.

But because it took so long to get the Medicare application sent in to Medicare, we had to prepare what is called a Medicare Reconsideration Request.

Medicare only gives a clinic an effective date of 30 days prior to the Medicare application being received by Medicare. Because it took months to make all of those name changes, during which the clinic had been treating Medicare patients, we really needed the effective date to be back dated. So we prepared a Medicare Reconsideration Request for the clinic to submit to Medicare requesting Medicare to give the clinic a back dated effective date, so that the clinic could still bill all of those dates of service to Medicare.

Also, because no one at the clinic had noticed or knew to pay attention to the entity name issue, when they set up the clinic billing info in their chiropractic software, ChiroTouch, they set up the clinic with the name “the” in it. They had been billing to all of the other insurance companies with the name “the” in it. So we had to go into ChiroTouch and set up their clinic billing set up correctly for Medicare. And then fix their demographics with the other insurance companies that they had been sending claims to with the wrong name.

This is one example of lots of issues to fix all because things weren’t set up the right way at the beginning. This is just one example of how important it is to set up everything correctly to avoid headaches.