I've currently got about $800 of EOBs (DOS ranging from 1/9/06 to 2/22) that the provider hasn't posted yet.

Naturally, I'm not paying any balances until they get the EOB (with the "Contractual Adjustment") posted.

I'm able to track the non-post because of my record-keeping in QMEM.

db

Quicken Lina asked:

We've heard from a couple of people that they have

actually found some very big (one over $1,000) errors

by using QMEM. Has anyone else? What was the error?

What did you do? Do you think QMEM helped?

Quicken Lina,

I had to smile at your subject ... unfortunately, I find a totally unacceptable number of billing errors for my wife, who is on a PPO network. As a general rule, EOBs are accurate but invoicing from providers (particularly hospitals and large multi-practice clinics) are a serious problem.

Generally, it's a data entry problem in converting the EOB to an invoice. The most common error is in applying the Provider write-Off (difference between the amount charged and the contract amount) and the co-pay of 10%. I suppose the EOBs from various insurance companies have different formats that confuse the provider's data entry folks.

prior to QMEM I clipped the office visit report to the EOB, calculated what the invoice should be, and waited for the invoice to arrive. With delayed invoicing or a numberer of provider visits, these paper clip stacks could grow.

With QMEM, I initially enter the provider, service, and any up-front payment. I add the EOB information when it arrives, set Pending:Provider, and file the documents. When the invoice arrives, I simply check QMEM for the correct amount due for the service and make payment. If there is a discrepancy, all of the info is in QMEM so the error source is pretty easy to detect. A clear advantage to the total paper system. :-)

I'm on Medicare and find that process much better, from the Provider accuracy point of view.

Wayward

Bingo. In many cases the "billing errors" are deliberate. I figure that about 20% of the time they get paid anyway, because it is almost too hard to figure out.

Think about why you get a billing from what looks like a professional corporation, but if you catch a break somewhere along the line, you find out it is really just the hospital masquerading as a PC. The only thing that might tip you off is the numbers are the same for the same D.O.S. Always ask yourself why and then ask them.

I've got a new billing error to add to the pile (in addition to the $800 referenced above, which is STILL in dispute).

$3,000 of radiation diagnostics that the provider NEVER submitted to my insurance, claiming that the procedure wasn't covered ... even though my insurance paid IN FULL (with the adjustment, naturally) for the exact same procedure last November. My wife remembered having previously had the procedure, but I was able to locate the DOS and the previous EOB because of my QMEM records.

NEVER BELIEVE A MEDICAL PROVIDER BILL!

db

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Edited by dbAnalyst at 05/09/2006 1:31 PM

Well, of the $800 dispute that I originally posted about, the provider and I have whittled the amount in dispute down to $300.

IN EVERY CASE for the "resolved" $500, my QMEM numbers were correct and their numbers/bills were wrong.

NOW there's a new fun-and-game that they've come up with for the $300. The "Contractual Adjustment", AKA the provider write-off, was supposed to be about $200, leaving $95 that I owe.

The provider posted the amounts BACKWARDS, and claims that I owe the $200!

As I said above, NEVER BELIEVE A MEDICAL PROVIDER BILL!!!

db

dbAnalyst said:

<snip>

NOW there's a new fun-and-game that

they've come up with for the $300. The "Contractual

Adjustment", AKA the provider write-off, was supposed

to be about $200, leaving $95 that I owe.

The provider posted the amounts BACKWARDS, and claims

that I owe the $200!

As I said above, NEVER BELIEVE A MEDICAL

PROVIDER BILL!!!

db ... Groan! This is the most common error I find with provider data entry ... confusion between the billed amount, the contract amount, and the allowed amount.

With MEM, I enter the EOB correctly and wait for the provider statement. Scanning the Pending Provider flags when the statement does arrive certainly helps catch the errors. Drives me nuts! :O

I've found one for over 1K, where the provider billed twice and was paid twice by Medicare, supplemental ins. and me. The provider's accounting head and I are going to have a 'discussion' about it once QMEM helps me nail the figures down.

I've also come up with some, legitimate that I'm not sure have been paid off by me. (Goose<<>>Gander).

--
Edited by Wiley at 05/09/2006 3:25 PM

Thanks everyone - this is great information. I am so happy that you guys are finding these things!

Quick question: after you spot the errors, do you use QMEM to help you resolve them? Do you have it open while you are on the phone with everyone?

I haven't used the dispute letters in QMEM, because I usually deal with matters on the phone or in person and, fortunately, things haven't proceeded to the letter-writing stage yet.

I'm fortunate that the "Patient Representative" at the provider and I have progressed to a first-name basis, almost a friendship, and she's provided me with her direct phone line. It's also UN-fortunate that we've needed to spend so much time talking. At least I've established sufficient credibility that, when I call, she realizes that there is a high probability that there really is a problem.

The first thing that I do when she calls, is to open QMEM so that I'll have MY records available. Or I'll take QMEM reports and the EOBs with me for meetings.

BTW, the $300 backwards-posting was straightened out this morning, and $2800 of the $3000 looks like it progressing reasonably. We're still dealing with the $200 remaining, but since it's the medical-group (radiologist) side of the $2800 (which is on the medical-center/radiology side) -- but otherwise the exact same issue, I fully expect a favorable resolution.

db

Quicken Lisa said:

Thanks everyone - this is great information. I am so

happy that you guys are finding these things!

Quick question: after you spot the errors, do you use

QMEM to help you resolve them? Do you have it open

while you are on the phone with everyone?

I enter dates of service and EOBs into MEM ... the wait for the provider invoice.

When an invoice arrives, I open MEM and check the invoiced dates of service against my MEM entries.

If I see a discrepancy, I dig the original EOB paperwork out of the file (to be sure I didn't screw up the entry) and make the patient services call. During the call, I have the invoice, the original EOBs, and MEM at the ready. ;-)

Wayward

I started using QMEM 2 days ago. Where do you enter the EOB's? Do you enter dates, amounts or both?

Since we're calling them "billing errors" for now, I thought what just happened pertinent. A billing shows up from hospital for $952.00 under "Medicare General Deductible".

I call up and am advised, with great certainty, that it is the deductible amount. "Every three months of a hospital stay you are charged the $952.00." My response was,"When did that happen?" I was advised to take it up with Medicare. I wasn't of a mind to do that so I advised her that a benefit period begins when a person is whisked through the doors of an institution (admitted)and ends upon that person not being in an institution for 60 days. She reconsidered briefly, told me the bill was wrong, that I'd get a new one and to have a nice day.

This is not an "error", but an deliberate attempt to defraud. Also unprovable.

I started using QMEM 2 days ago. Where do you enter

the EOB's? Do you enter dates, amounts or both?

Depending on your insurance company, your EOB may have multiple Expenses <capitalized to indicate that I'm using the QMEM specific meaning of the term>. An Expense is a medical charge for a specific person associated with a specific Date Of Service.

Create an Expense entry either in the Expense Log or using the "Enter Expense" button for each Expense on the EOB and fill in all of the fields you can.

If you have any further questions about this, please read the existing posts in the <url=http://www.quickenforums.com/forum.jspa?forumID=1019>Entering Expenses</url> or the <url=http://www.quickenforums.com/forum.jspa?forumID=1018>Getting Started...</url> discussion groups. If you still have questions, please post them there as those types of questions are off-topic in this discussion group.

-Tony

Wrangler,

I'm dealing with Medicare also. The last Part A deductable I saw was $912, but that was last year.

In terms of entering Medicare Summary Notices (MSN) I have setup insurances of 'MCA - Hospital', 'MCB - Outpatient Facility Claims', 'MCB - Assigned Claims'. For an MSN I enter all the amounts, by service start date, that I can (MCA you have to kind of back into the amount billed from their actual bill or your supplemental insurance EOB).

In the 'Paid on' I enter the print date (top right corner) and in the 'Reference' I put the claim number. For supplemental I do the same.

This has allowed me to get back to a specific MSN or EOB instantly. You almost can't enter too much info.

For your question on the $952 deductable, I'd give Medicare a call. They may be able to 'educate' the hospital billing dept. It probably isn't fraud but stupidity.

--
Edited by Wiley at 05/15/2006 5:45 AM

Minor example.

Recently got a full bill from a lab for my wife's test, telling me that it had been denied by her health plan.

Hmm. I called the insurance company, they said they'd never received the bill, but that if they had received it they would have covered it.

I called the lab, they said they didn't have the insurance information, which I clearly remember giving them a copy of at the time of the test. (Funny thing, "not having the insurance information" doesn't seem to me to be the same thing as "denied by your health plan"... but maybe that's just me.) So the lab took the insurance information over the phone and said they'd "resubmit" the bill to insurance (!) and I should hear back in 8-10 weeks.

And yes, insurance took care of it immediately.

(I cannot tell a lie -- I would have gotten this without MEM -- but it helped me keep track of exactly where things were... :) )

- Bruce

Welcome to the club, Bruce. ;-)

For some providers it seems easier to simply bill you rather than jump through the insurance submission process. Unfortunately, I suspect that a high percentage of folks simply pay up ... unless it is a substantial amount. Improper due diligence on both ends ... but now we have the MEM edge! :8}