Patient Advocate

[Steve Verno]

Thank my new daughter in law and one of my doctors.

She was admitted to the hospital.  She is unemployed and has no insurance.  The bills are coming in the door like snakes on a plane.  She has no clue what they are or how to handle them. 

My next door neighbor was also in the hospital.  He has Medicare and he doesnt know what the EOBs say when he gets them and he doesnt know about the bills he's getting.

One of my doctors charged for a visit I know didnt happen and hes passed the bill onto me because my insurance denied it.  I spoke with customer service.  They sent him a medical record request which he ignored, hence the denial.  Ive done the same and he's ignored it too.  His latest letter was that he has turned my account over to a deb collector.  I disputed and he ignored the dispute.  Now, another bill came in, only this one has finance charges added to it.   He's violated HIPAA, the FDCPA and FDCRA, and the False Claims Act.  I tried speaking to his staff and they are such jerks.  The call started with intimidation but THE BEAR dont intimidate easy.  He's under investigation by State and Federal agencies.  THE BEAR terminated the provider-patient relationship.  My friends call me THE BEAR and they like to say, Dont poke the bear!  Luckily, THE BEAR, is able to know what to do,  a patient has no clue. 

If we can get our hospitals and large practices to start a patient advocate program, we can help hire the newly educated billers find a job.  I feel it will pay for itself.  How, you ask?  Simple:  Mr. Magoo is seen by a doctor.  He has ABC Insurance.  ABC is denying the medical care as not being medically necessary.   The advocate uses their coding and billing training to get the denial overturned and now the claim is paid.  The patient lives on $500 per month in social security.  The advocate works with the patient to make monthly payments that are within the capability of the patient, so the advocate brought in both insurance and patient revenue where without the advocate, nothing is brought in.  This also gives the newly grtaduated student the ability to see the dark side of the medical profession, they develop communication skills, and they learn how to succeed, not to mention develop the experience asked by some doctors.  Their reputation as a success could get out bringing in job offers. 

[Steve Verno]

Every day, I see and I am asked to help a patient whose health benefit has been denied payment or the service itself has been denied.  I also have my neighbors who get medical bills and EOBs, and to them the documents are like Egyptian Hyoglyphics. 

Hospitals and practices need to hire medical billers, not to work in the billing department but to act as a patient advocate.  if the patient gets a medical bill that doesnt look right, or they get an EOB that they dont understand where the claim has been denied or applied to an out of pocket expense, the medical biller/patient advocate can use their training and experience to assist the patient to better understand what is happening.  The medical biller/patient advocate can work with the patient regarding any out of pocket issues.  This could be in the form of reasonable payment plans. Assisting with the appealing of a benefit denial.  If the patient feels their medical bill is too high, the advocate can look at the medical record to see if the codes being billed are correct.  The problem may be that the patient went to see a podiatrist and the podiatist is charging a level 4 consult code.  The record only supports a 99203.  So, instead of paying $450 for a 99244, the patient pays $150 for a 99203.  This also keeps the doctor out of hot water for charging for services not documented or rendered, which could be deemed as fraud. 

The medical biller/patient advocate can be someone who just graduated from any billing class, whether the class was on-line such as with the Medical Association of Billers classes or from a local college or univerity such as Lake-Sumter Community College or Everest University. 

If Medical Billers have problems with medical billing just think of a patient who has no training or idea of what is happening to them.