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Medical Billing Clearinghouse: How to Settle Medical Billing Disputes

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Health care insurance billing is very complex and can be quite confusing. At some point in time you will no doubt find yourself in a billing dispute trying to determine what has been paid for and what payment is due. It’s important to know how to dispute a medical billing issue, how to appeal a denial and to be able to strengthen your case for receiving payment.

The best prevention is a little preparation up front. Make sure you keep a record of all communications you have about the patient’s healthcare. You will want to note phone calls made with the date and time of the call, the number you called, the people you spoke with, and exactly what you discussed. Also save copies of emails or written communications.

You will also want to have a copy of the insurance plan’s Summary Plan Description (SPD) on hand for reference. This document clarifies all billing services covered by insurance. You will also find a list of any exclusions in it. If you have questions about the policy, you can use the SPD to find the answer.

When there are billing discrepancies, you will want to be certain first that the health care provider billed the correct insurance plan. Simple errors in name, policy number, or address can result in rejected claims. It’s important to understand your plan’s annual deductible, the different terms and limits set forth in the plan for the medical services.

Also check for errors and make sure all charges were applied correctly to the insurance provider. You will want to make sure that there aren’t multiple bills being sent for the same service. If a payment was delayed, it’s not uncommon for a patient to receive a follow up notice for the same service although they may have already submitted the payment.

If a claim has been rejected or denied, find out the specific reasons why. When a patient disagrees with the reasons, they may file an appeal with the insurance company. It’s important to take this action quickly and provide any documentation supporting the patient’s position.

While we are certain you will be faced with questions about medical billing and insurance coverage, we can simplify the record keeping process and minimize errors for you with our electronic billing software.

Contact Apex EDI to request a demonstration of our software today.

Posted in: Medical Billing Clearinghouse

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