[kamarg]

> Recovery is beyond the scope of most small practices.

Seems like a business opportunity. Could probably work very similar to other collections agencies where they either buy the debt for pennies on the dollar or take a percentage of the collected amount.

[toast0]

Yeah, there's an industry of companies that insert themselves between the medical record and the insurance company to upcode claims and get better payments. This article is about the reverse process, where the insurance company looks at the claims and downcodes them to send worse payments.

IMHO, in office care should be more of a time and materials billing than billing based on procedures done. Of course, then the doctors' billing office would aggressively measure time the doctor spent, and the insurance company would suggest the doctor took too long for whatever.

[brewdad]

It's much easier to treat it like identity theft where the business's problem becomes the customer's problem to solve. In this case, insurance didn't pay what was required so the patient does. There's already a potential collections agency involved if the patient doesn't pay.

Who do you think is easier to squeeze the money from? A mega-insurance corporation or your sick grandma?

[datadrivenangel]

Sending your patient's 'debt' to collections promptly is very unpopular with the patients, and the insurance companies will 100% insist that the patient is responsible.

[lozenge]

You'll notice the doctor's office in the article already has a team of billing experts. But instead of working on new claims, they are being forced to relitigate claims they already submitted that weren't accepted.