Published - September 2002

By Dave Jakielo

Q & A

The HBMA Fall Conference in Washington D.C. this past September was a great success. It was good to see so many HBMA'ers enjoy each other's company as well as benefit from the excellent educational content. We had fun, as usual, at the annual auction, too.

The conference is a great opportunity to interact with other "billers" and to trade war stories and questions. It made me think this might be a good time to clear up my e-mails and answer a few questions that have been hanging around for sometime. So this month's article will have a new twist-it's a Question and Answer format and hopefully will provide those elusive, definitive answers you have been seeking. Here goes:

Q. Why have the number of denials increased in the last year?
A. When you come right down to it, there isn't any incentive for an insurer to pay a claim. The insurance company wants to hold onto the money for as long as it can. The employer knows that when claims are paid their annual cost will rise in the next contract period based on utilization. So, who's fighting for the patient and the provider? Yes, it's HBMA billing companies leading the charge. This issue will get worse before it gets better.

Q. What does the acronym HIPAA stand for?
H= Healthcare
I= Insurers
P= Postponing
A= All
A= Adjudications

Q. How should my phone representatives handle the new patient privacy issues?
A. The preferred method is to have the patient send you a DNA sample for proper verification and identification. Preferably via your fax machine. Caution, the paper in you fax machine may get soggy.

Q. My clients tell me they are working harder and making less money. How should I respond?
A. Blame it on the new "Reality" TV shows. Ever since "Survivor' aired we all have been trying to survive.

Q. Third party payer guidelines sometimes do not seem to be cut and dried. When I read the regulations, sometimes I feel the answer falls in a gray area. What should I do?
A. Check your glasses. Your photo tint lenses may not be clearing up when you are inside. This has to be the answer because we all know the third party payers' regulations are as clear as mud.

Q. When our accounts receivable representatives are following up on insurance claims, why is it that many times the third party payer tells us they didn't receive the claim, when our system indicates it was submitted?
A. Because they can.

Q. Why is Congress always bringing up the issue of a prescription drug plan for seniors?
A. I don't know exactly why, but it seems that since the introduction of the new prescription drug Viagra, it's hard to keep a lot of things down.

Q. When marketing my services, what should I tell my potential clients is the best reason to use an HBMA billing service instead of doing the job in-house?
A. Because we HBMA'ers are a great bunch of people, we have those fancy initials after our names which proves we're experts, and because we need the money.

Hopefully the above questions and answers will be beneficial to the many who have recently wondered or inquired about these issues. I may not have all the answers to today's health issues, but I'm always happy to share what I do know.

If you have questions or ideas on topics for this monthly feature, contact Dave Jakielo, Seminars, Training and Consulting, 86 Hall Avenue, Pittsburgh PA 15205-3214. Phone and Fax: 412-921-0976. Email Web page (which includes past articles):

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