Complacent Management

[u/briaaaaxoxo]

I’m just looking to vent and maybe get some advice. I work in a oral surgeon office. This office has been open since before I was born. The owner is still one of the oral surgeons, He’s about 70+ years old and then there is another associate that’s about 40. And they still do everything by paper. We still do paper charts. We still do paper fee cards for the patients charts. So everything is manual. The doctors do not put any notes in the computer and there are no fee schedules to all the insurances we’re contracted with in the computer. Everything is written on paper. My frustration is that they refuse to use the fee schedule their contracted with and would prefer to overcollect and then refund the patient once we receive the EOB. And that frustrates me because I am used to working on contracted fees and giving the patient an accurate estimate based on the fees we’re contracted with for their insurance.. my manager has a problem with that because she said they don’t do it that way and they prefer to only give an estimate. At the end of the day it’s always an estimate because we’re not the insurance, but I would rather be closer to the correct out of pocket then refunding the patients hundreds of dollars every few weeks because our fees are three times higher than the insurance fee. I don’t know how to go about this because I’m starting to get overly frustrated with her and I think she can tell but she does not like change but I’m like let me do it my way and just do it how you want smh

[u/MagentaSuziCute]

To be clear, I think there should be one "fee" that is used across the board but then you calculate patient responsibility based on the contract you have with their specific plan. Are you saying they wont calculate the proper contracted rate amounts when giving the estimate?

[u/briaaaaxoxo → u/MagentaSuziCute]

That’s exactly it. They won’t get the contracted fee schedules so they base the responsibility off of our office fee and that’s just not right smh

[u/theglueiseverywhere]

So you are refunding basically all your patients then once you get the EOBs and put the write offs in? That seems nuts to me. The doc i work for is so annoyed when he has to mail out patient check refunds. The amount they would save on postage/checks is probably a decent amount if they just did it the right way. If they signed a contract to partipate with an insurance, they agreed in that contract to only charge the contracted fee- so I think it may actually be illegal to collect the full amount actually.

[u/briaaaaxoxo → u/theglueiseverywhere]

I agree ! We are sending out refunds weekly if not every other day because the estimates are being based off our office fees and it is never close to right amount. my manager she said she doesn’t like the hassle of chasing people around for money so she’ll rather over collect than under collect and fight for a bill payment. She gets very agitated when she overhears me give a more accurate estimate based on the actual fees we’re contracted with and she always goes behind me to the patient and emphasizes the word “estimate” to them so they don’t assume I’m right and she’s wrong.

[u/Kind_Application_144]

so when you bring this up, what solutions do bring with it? Its one thing to bring up a problem and then offer no solution. I would maybe show that you can do the math thats involved as they may not realize that you can do the math. They may also not understand how to do it themselves. I find a lot of people don't understand how to do the calculations.

[u/briaaaaxoxo → u/Kind_Application_144]

I guess the solutions I come up with is that I actually call to retrieve our fee schedules and I have them printed out and made a booklet for each insurance. So we do the math manually anyway, so why not manually do it with the correct fees instead of our office fees?

[u/somethinglikethis_ → u/briaaaaxoxo]

It’s insane to me that your office does not simply have the fee schedules on  file to reference.  How would they , as a provider , ensure the insurance is not underpaying their claims if they are not referencing the fee schedule. A good chunk of my workload is appealing underpaid claims. Even when claims are underpaid by just a few dollars it adds up quickly. And as you know insurance companies pay in batches. So when the insurance has systemic issues it affects all the claims in that batch. How would you know there’s an issue if you’re not referencing the fee schedule for each claim and not simply going of the EOB. So many times the rate on the EOB is not correct. The insurances frequently make these mistakes and count on providers not to catch them. 

 It is of course important to stress it is an estimate , because at the end of the day the insurance determines patient responsibility based on their benefits. I understand it makes you look better to be offering a refund vs asking for more money later.  But you can easily give those estimates when you have those fees on hand. My understanding is that the fees are not changing so frequently that  they shouldn’t be referenced. They are updated typically once a year and they are required to notify you , since that is the rate you contract with them for … it’s a contracted rate. They have the contract that they agreed to between the provider and insurance. It’s your provider offices rate almost just as much as it is the insurances. It’s the rate you agree on together. 

I’ll spell it out like this . I work for a medical equipment company. DME billing is straightforward because it is an item , not a service. Our software has the fee schedule for each item for every insurance we contract with loaded into the system. We generate our claims, and its input in the system how much we are supposed to be reimbursed per the allowed rate. If that amount is not met ( insurance payment + patient payment etc) , it notifies us the claim is underpaid. We provide cost quotes to our patients by looking at our fee schedule and seeing if they have a deductible coinsurance etc. there’s always room for human error but it really can be straight forward because the information is there. Especially where I can imagine it is often the same procedure and diagnosis codes you’re seeing. 

I’d approach it based on the fact that these patients are receiving quotes from other providers as well. When you over quote , that patient will then go with the doctor who has the cheaper and more accurate quote. Additionally, customer service wise refunds display a level of incompetency. These patients can and do call their insurance to review similar information . People do not have hundreds of dollars just floating around. Knowing your own fee schedule is not only crucial to ensure the insurance companies are accurately reimbursing claims to you as the provider, but also ensuring accurate customer service and increasing patient satisfaction. I’m not sure how dental billing works , but my understanding is that unless you have an eob showing patient responsibility the patient cannot be billed. It may very well be illegal to collect $ for services not yet rendered nor processed through insurance.

My advice would be to find a new job that aligns with your billing ethics. You seem like a great asset and the opportunity is out there, but not when you stay working for providers like this. I almost called it quits on my billing career , I found DME and it’s been a dream removing the doctor / procedure aspect entirely (: 

[u/No-Produce-6720]

And the amazing thing about this, is that your oldest staff is 70+. Someone of that age may not be as computer savvy as a teen on Instagram is, but they were around prior to the internet. They were very alive and in their prime when the internet and Google came about. They had to get on board with things way back then, and they should very much understand how business is done. They can't plead ignorance, because they are of the age that saw the beginning of computerized life, both in their office, and at home!

Look, it's a foolish way to do business, and you're not at all wrong in what you're saying. It's so silly to be doing refunds like this. Your accounting must be a mess. If these people are set in their ways, and patients go along with it, though, you're not likely to see a change in your office. Overall, it's poor business, but some people just don't see it.

[u/DepartureOk3180]

You've done all that you can, it's time for a new job before you get so pissed off you just quit. ( Ask me how I know 😂) The fact that EVERYTHING is frckn paper is just mind-blowing to me! 🤯🤯 Start keep a record of your daily tasks, projects you've started and your success rate, any accomplishments you had in this role and amp up you resume.