Crack Down on Payers
State insurance agencies are on the medical biller’s side.
Medical billers are the financial liaisons between doctors and patients. Billers have to deal with insurance companies that do not want to pay for services rendered by physicians. This aspect is a big problem for medical billers. However, recently insurers have been fined over $12.8 Million for tactics such as described above. The specifics of the fines are described below:
- Regence Blue Shield – $100K for denying women the removal of birth control device
- WellPoint – $100K for failing to report security breaches
- Blue Cross Blue Shield of Delaware – $325K for denying cardiac services
- United Health – $1M for anti-competitive behavior
- Humana – $3.3M for failing to promptly report Medicare fraud and abuse
- Horizon – $8M for the way that it handles claims
Notice that the largest fine was for the way that Horizon mishandles claims. Medical billing is difficult due to the complexity in codes and added to the problem is denying of claims so it is good to know that state insurance agencies are on top of the insurance companies to get them to paid for the claims fhat you are processing.
