7 Tips for Avoiding Potential Billing Disputes

Updated on July 3, 2015

frugalcheapwebBilling disputes are a common complaint that medical practices face today. While many physicians are trained in medicine, few do not how to run a business properly. Oftentimes, if you can clearly communicate your billing policies ahead of time and educate your patients on how their insurance plan works, you can often avoid any potential conflict.

We spoke with two billing experts who offered some helpful advice on how to better interact with your patients so you can minimize patient complaints about billing errors.

Help your patients understand their bill

According to Joshua Greenberg, chairman and President of San Mateo, Calif.-based HealthCPA, a provider of personal health care financial advocacy services, many billing disputes are due to the fact that medical bills are hard to read and most people do not understand how their insurance plan works. Because of this they could become confused by the various numbers they see on their bills and insurance statements.

“Therefore, many times billing disputes can be easily cleared up when billing office staff walks patients through the numbers they see on their bills, using plain language,” he says.

Additionally, many patients see the billed amount on the invoice and think that is what they are being charged. Greenberg advises that your billing office staff can explain to patients that they receive a discount through their insurance company and then explain any insurance payments that were made and why the patient owes the final amount charged.

Explain to patients how their deductible works

Many patients do not understand that they must pay their deductible before insurance pays anything, and they may have just switched to a high deductible plan, which will make this a bigger burden for them.  

“Patients may think that they do not need to pay the amount they are being charged because insurance should be paying some of it,” says Greenberg.  

As a result, billing office staff should just explain to patients how their deductible works and that they do owe the amount charged. Melissa Turner, founder and CEO of Mainstream Services Medical Billing, Inc. In South Holland, IL, adds that you should ask the patient if they have a copy of their Explanation of Benefits (EOB) available to allow you to go over it with them.

“Explain each charge on the EOB as simply as possible without using industry jargon,” she says.

Inform your patients of all lab costs upfront

Lab bills can also confuse patients. If they paid a copay at the doctor’s office, they believe they are all set and get frustrated when they get a lab bill.  

Greenberg says that you can avoid this scenario by telling patients in advance that they will be charged separately for their lab work.

“But if the bill arrives and the patient complains, all billing staff can do is apologize and explain why the lab bills separately and why the patient owes the amount due,” he says.

Verify that your claims are processed properly

Billing complaints can also result when, instead of following up on a claim denial with the insurance company,  billing companies turn around and bill patients for the full amount owed.  

“It is important to double check that claims are processed correctly and appeal any claims that are denied in error,” says Greenberg, “so that patients do not get charged for more than their fair share of the bill.”

When there is a billing dispute, it’s best to also keep detailed notes in the patient’s record. Turner says to send a follow up in writing to the patient detailing the dispute and resolution.

“Always end the interaction ensuring the patient knows they are valued by the practice and advise them to follow up with their insurance carrier if they have any other questions concerns regarding the bill or level of payment,” she says.

Be empathetic towards your patients

With all patient billing complaints, the key is to sympathize with patients and acknowledge that bills are confusing and that it’s understandable that they are frustrated. If the bill is indeed wrong, billing staff should admit this and fix the problem quickly, but more likely than not, the patient just needs help understanding their insurance plan and why they are being charged.  

“Billing staff should take the time to explain things to patients, without being defensive and without condescending to them,” says Greenberg.

Turner agrees, and adds that you should always completely hear the patient out as you can usually determine where any confusion about the billing stems from.

“Acknowledge the patients right to question any charges they feel are incorrect,” she says. “Be sure to remain friendly and do not take the patients questions or demeanor personal.”

Respond immediately to any billing disputes online

If a medical practice receives a bad review or a billing complaint online, it can be tempting to respond publicly to set the record straight. However, this approach could serve to escalate the problem, and could make the practice appear defensive.  Greenberg says that the best thing to do is to respond directly to the patient to address his or her concern, respectfully and out of the public eye.  

“Hopefully this will win the patient over and he or she will delete or modify the online comment,” he says. “However, it is impossible to win everyone over, and at some point it may be unavoidable that the practice will have to live with a few negative online reviews.”

Hire or appoint a patient advocate

Finally, in order to avoid billing complaints, Greenberg believes that it’s a good idea for every physicians’ office to have one person who acts as a patient advocate to help patients with all of their billing and insurance questions.  

“Practices will find that offering this service will help them attract and retain more patients, and that it can reduce overhead costs by eliminating some of the back-and-forth between patients, the doctor’s office and insurance companies,” he says.

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Daniel Casciato has his own business as a social media consultant, freelance copywriter, ghostwriter, and ghostblogger. The Pittsburgh native loves his Steelers, Penguins, and Pirates. Learn more at www.DanielCasciato.com.