| In a previous installment of medical billing goofs, we | | | | So they begin the questions starting with name, |
| discussed what happens when you bill the wrong item | | | | address, etc. Well, when the patient gives the carrier |
| to a carrier and how you can be charged with fraud, | | | | his street address and state, the carrier responds with |
| but what happens when you send a bill to the wrong | | | | the following. "Sir, Texas is not in our region". Well, it |
| carrier. What follows is a genuine story. It's kind of | | | | turns out that the patient had the same street address |
| funny when you read it, but the truth is, it's far from | | | | as another patient in New York. Everything was |
| funny. This is some serious stuff. | | | | exactly the same except for the state, which nobody |
| A medical billing company, we'll call them XYZ | | | | bothered to check. So what happened was that the |
| company, was sending out a claim for a patient, we'll | | | | patient had his claim sent to Medicare Region A when |
| call him John Smith, to Medicare Region A, which is in | | | | it should have gone to Medicare Region C. |
| the New York area of the United States. Now in | | | | Everybody had a real good laugh about this, but the |
| actuality, the name of the patient was a common | | | | problem still wasn't solved. Now the claim had to be |
| name so there could have very well been many | | | | forwarded to Medicare Region C. The problem was |
| people with that name. | | | | that the medical billing agency was not licensed to bill |
| Anyway, the bill makes its way to Medicare Region A | | | | Medicare Region C. They only had a package to bill |
| and the response from Region A is that they are not | | | | Medicare Region A. So now they had to see if they |
| going to pay the claim because the patient that the | | | | could get Medicare Region A to forward the claim to |
| company was billing was dead. Well, to make a long | | | | Medicare Region C. Well, they could, but there was a |
| story short, the medical billing company gets on a | | | | charge for this. Well, the medical billing agency said no |
| conference call with Medicare Region A and the | | | | way. So what did they do? |
| patient. On the one end, the patient is screaming at the | | | | They got a hold of another medical billing agency that |
| carrier, "How can I be dead? I'm right here". The carrier | | | | did bill Medicare Region C and arranged to do a swap. |
| simply responds that according to their records, the | | | | They'd bill one of their patients for them, thus incurring |
| patient is dead. | | | | the cost, if they'd bill Medicare Region C for them. The |
| Well, this back and forth goes on for quite a while with | | | | company agreed and sent the claim. The problem was |
| quite a few phone calls. Finally, Medicare Region A | | | | finally solved. |
| decides that they're going to go over the patient's | | | | You can't make this stuff up. |
| records with the patient and the medical billing agency. | | | | |