Health insurance companies may request a copy of billing records to substantiate claims for payment. If not provided in a timely manner, the company could report physicians who fail to comply to the state medical licensing board. Unfortunately, additional problems can arise if the requested records are provided but put together poorly.
Here is a sample breakdown:
- Failure to comply with insurance company’s request in timely manner: A physician out of California provides an example. Anthem Blue Cross requested copies of medical records for eight patients. The physician passed the task along to an administrator, who forgot to follow through. As a result, Anthem put payment requests from the physician through a prepayment review process. This resulted in significant delays in payment and frequent denials.
- Comply, but poorly: If the records are not carefully presented and accounted for, a poorly structured reply can result in a denial of payment or accusations of fraudulent billing practices.
This leaves private practice physicians in a conundrum: how should they respond to requests for billing records? The reality is, insurance billing audits are on the rise. If your practice has not gotten such requests yet it will likely receive them in the future. These requests can result in a demand for repayment. Meeting this demand does not mean the insurance provider will cease such requests. It can trigger additional requests and higher demands. Do not let insurance companies sidetrack your ability to provide quality care to patients. Seek legal counsel if a company is making false accusations or wrongly denying claims. An attorney experienced in these matters can advocate for your interests.