Practice Management Alert

Question: Since January, our medical office has been having major problems when billing our Part B carrier. Sometimes the carrier processes the claim using outdated codes, sometimes it applies improper bundles to our codes, and other times it takes much too long for it to pay a simple claim. Is this just bad luck, or is there a more concrete reason for these Part B problems?


Minnesota Subscriber
 

Answer: There may be a very good reason for your Part B billing woes, especially if your carrier recently switched to new software that's had a hand in mucking up the Part B payment system for several medical billing offices.

There has been a recent rash of Part B carriers moving over to a software program known as the Multi-Carrier System (MCS), and the transition has created billing nightmares for many medical offices. If you-ve received some mysterious denials or delayed claims, you could be suffering from MCS-related gremlins.

Carriers Still Making MCS Move

Many insurers moved over to the MCS a year or two ago. But several more made the switch at the beginning of this year, and others, such as Blue Cross and Blue Shield of Kansas, just transitioned on Sept. 6.

Even carriers that have been running the MCS for half a year may still be struggling. Common problems include:

- Freaky denials. Some carriers started applying bundling edits improperly when they switched over to the MCS, says Holly Louie, compliance officer with Practice Management Inc. in Boise, Idaho. In many cases, the carrier will recoup payments improperly.

Also, Part B carrier AdminaStar Federal has been denying claims due to old insurance coverage, says Sarah Myers with Family Practice Associates of Lexington, Ky.

For example, if the patient had a workers- comp claim in 1993, the carrier will suddenly start denying claims because it thinks the 12-year-old workers- comp coverage should pay instead. -Their records were going kind of wacky,- Myers says.

- Frustrating delays. -So many claims have been held up for so long- because carriers were trying to fix multiple problems, Louie says. -The systems weren't able to talk to each other.-

- Weird downcoding. AdminaStar was downcoding some evaluation and management claims automatically, Myers says. She believes the problem has been resolved at AdminaStar, but watch out for similar mishaps if your carrier transitioned recently.

The answers to the Reader Questions were provided and/or reviewed by Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in  Spring Lake, N.J.