Unfortunately, those sitting in that "hot seat" that is... whose responsibility it is to collect the "oh so (censored) co-pay" have an unfair reputation of being the "bad guy." My favorite complaint always was.... "My insurance did not pay for my last visit and when I called my insurance company, they said you listed the wrong code on my claim. Fix it so the doctor can get his money." How do you respond without taking it personally....getting defensive...fighting back? And as if that wasn't enough, after taking the time to try to explain to this patient that your coding was justified according to the treatment they received, they walk away and complain all over again to the doctor (or any other staff person who will listen)...as if your response didn't even count!
Much as you may want to, the success in reaching these patients is NOT by letting off steam OR blowing them off for that matter, but rather by responding to them in an intelligent, caring way that will serve to educate them as well. Let's take the coding scenario above and discuss some simple points that might help eliminate a similar problem in the future. Of course, the best strategy of all is a PRO active one. Making sure your patients understand the billing policies of the practice BEFORE they receive a denial from their insurance company may help having to try to fix it after wards.
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Make a list of the 10 most common complaints that you hear on a regular basis, then give serious thought as to how to best address each complaint by preparing ahead of time, a script to address them in such a way (without going into too much detail) that will help to create better patient understanding in terms of what is and isn't covered and what they can expect. Be honest and open. Memorize and rehearse these scripts so that you can deliver them as naturally as you do your own name.
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When a patient comes to you with one of the dreaded "Top 10", don't immediately tune her out by replying, "I TOLD you LAST TIME you were in that this was a non-covered service!" Even though this may be a repetitive billing complaint and you KNOW that it was coded properly, stop, take a deep breath and extend to her the courtesy of
listening
to her complaint. If you find it is something different, inform her that you will look into it. This helps build a trusting relationship with the patient.
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If things appear in order (as you suspected), explain (once again) why these services were not approved (using your script information) which may sound something like this..."Mrs. Jones, I'm sorry you feel there's been some error in the way we coded your claim and I understand your frustration; however, in reviewing your records, I've found that the proper code was submitted for the service you received and unfortunately, that cannot be changed. The fact is, your insurance company has determined that treatment of (corns and calluses) is not an allowable service and if you recall, we advised you up front that these services would be denied, based on previous denials. If we change the code in your case, to make it more "payable," we would actually be committing insurance fraud and Dr. could even have his/her license taken away as a result! You wouldn't want us to do anything against the law, would you Mrs. Jones?"
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Offer to answer any questions this patient has and before responding to them, repeat the question in order to clarify what exactly her concerns are so to address them properly. Also offer to keep an eye out for future claims, advising her of any changes which would entitle her to reimbursement.
- Engage the rest of the staff (and especially the doctor too) in your program so that you all demonstrate consistency in your answers should she bounce from one person to another in an effort to get a "better" response.
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When we receive patient complaints about "overcharging" for a particular service, I like to share with them the doctor's opinion on the insurance structure, which has always made sense to me. As you know, presently when we submit a claim, we are required to indicate a fee associated with a particular code; however, regardless of the amount we charge, we are PAID based on the contracted fee pre-determined by the insurance company. Many times there is a difference in fees, which results in our patients receiving a misleading written communication to this effect: "Your doctor charged over and above the reasonable and customary fee." Even though the patient is not charged the difference, we look like the "bad guys" in their eyes, just for "supposing" that we were trying to get more money than we deserved.
Doctors recognize (and so should patients through our educating them) that their responsibility is to properly code the service(s) provided, but because we are forced to indicate a fee along side it (or the claim would reject for lack of information), an adverse financial wedge is automatically created in the patient-doctor relationship. It seems it would almost be better if we were just required to put the code down without a fee. The insurance companies are going to pay based on their fee schedule anyway. The patient's response to all this?"Hmmm...I never realized that." Now they do.
