3rd Party Billing Company Requests

[Therapist4Chnge]

Yet another thing you weren't taught in your program and likely weren't warned about if/when you went into private practice...BPOs.

I thought it worthwhile to post a thread about 3rd party billing companies, which are often also know as Business Process Outsourcing (BPO) companies. BPOs also handle other aspects of back-office stuff for insurance companies, but claims and billing are where we are most likely to encounter them.

BPOs work as a middle-person to "negotiate" reduced rates for the insurance company. This is different than what you negotiated with the insurance company, as the discount would be *on top of* your current rate. The request can often look confusing and imply that accepting the discount will somehow benefit you (Narrator: It won't). They basically are asking for you to discount your rates in exchange for.....nothing. The discounts seem to be anywhere from 10%-25%+, which is how they typically get compensated by taking a portion of the "savings" for their clients (i.e. insurance companies).

I haven't accepted commercial insurance for years, but back when I did, these were received regularly...typically via fax. Back then everything was hardcopy, so they were consistently wasting multiple pages per day, which adds up when you are the one paying for ink, paper, etc. It's more of an annoyance if you get digital faxes, but I still don't like them cluttering up my inbox. Today I started receiving them for Workers Compensation companies, which is new (to me). It's the same setup and pitfalls as commercial insurance offers.

I don't really see an advantage to accepting an offer, but maybe there are some? I'd be curious if anyone has accepted the discounts and why they did it.

As for what to do...*not legal advice*....I have found it helpful (for me) to respond clearly to decline the "offer" and to state that I do not want to be contacted in the future with solicitations for the same. Some companies will fax *a lot*, especially if you see a lot of patients from one of their clients (i.e. insurance companies), so just ignoring them can still be annoying. I always keep copies of the request and my response. Some clinicians will write on the request and fax it back, but I find it more useful to e-mail and keep a copy in case I "accidently" get signed up, which happened at least once back in the day.

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[medium rare]

Yet another thing you weren't taught in your program and likely weren't warned about if/when you went into private practice...BPOs.

I thought it worthwhile to post a thread about 3rd party billing companies, which are often also know as Business Process Outsourcing (BPO) companies. BPOs also handle other aspects of back-office stuff for insurance companies, but claims and billing are where we are most likely to encounter them.

BPOs work as a middle-person to "negotiate" reduced rates for the insurance company. This is different than what you negotiated with the insurance company, as the discount would be *on top of* your current rate. The request can often look confusing and imply that accepting the discount will somehow benefit you (Narrator: It won't). They basically are asking for you to discount your rates in exchange for.....nothing. The discounts seem to be anywhere from 10%-25%+, which is how they typically get compensated by taking a portion of the "savings" for their clients (i.e. insurance companies).

I haven't accepted commercial insurance for years, but back when I did, these were received regularly...typically via fax. Back then everything was hardcopy, so they were consistently wasting multiple pages per day, which adds up when you are the one paying for ink, paper, etc. It's more of an annoyance if you get digital faxes, but I still don't like them cluttering up my inbox. Today I started receiving them for Workers Compensation companies, which is new (to me). It's the same setup and pitfalls as commercial insurance offers.

I don't really see an advantage to accepting an offer, but maybe there are some? I'd be curious if anyone has accepted the discounts and why they did it.

As for what to do...*not legal advice*....I have found it helpful (for me) to respond clearly to decline the "offer" and to state that I do not want to be contacted in the future with solicitations for the same. Some companies will fax *a lot*, especially if you see a lot of patients from one of their clients (i.e. insurance companies), so just ignoring them can still be annoying. I always keep copies of the request and my response. Some clinicians will write on the request and fax it back, but I find it more useful to e-mail and keep a copy in case I "accidently" get signed up, which happened at least once back in the day.

Welcome to the club. As I have posted several times before, I do not take any insurance. At present, I have a grand total of two (2) Worker’s Compensation patients in my practice whom I inherited as a favor to a colleague. This is two more than I would prefer to have.

Every month, I receive these faxes requesting the discount for each patient. Every month I decline them. When I first started receiving them, I asked to have them stop to no avail-it’s just status quo with them at this point. I have noticed if I don’t respond/forget to send back the declination, there is a delay in payment from Worker’s Comp. So, it’s best just to decline and send it back…

 

[Ollie123]

Maybe we start a business where we blanket fax insurers pre-auth lines and ask for an additional 25% increase in rates separately for every individual appointment for every patient that gets seen? I know some folks who could set us up a server to do this on the cheap. I mean, I don't think it will actually get anyone more money but we could run the fax equivalent of a DDOS attack on insurance companies and then report them to their state insurance commissions once their response metrics tank. I can think of quite a few providers who would happily kick in some money to make this happen.

😈


....I don't even see patients anymore.

 

[Therapist4Chnge]

Maybe we start a business where we blanket fax insurers pre-auth lines and ask for an additional 25% increase in rates separately for every individual appointment for every patient that gets seen? I know some folks who could set us up a server to do this on the cheap. I mean, I don't think it will actually get anyone more money but we could run the fax equivalent of a DDOS attack on insurance companies and then report them to their state insurance commissions once their response metrics tank. I can think of quite a few providers who would happily kick in some money to make this happen.

😈


....I don't even see patients anymore.

I would *gladly* contribute to this noble cause.

Another 3-4 requests today. They haven't reach "I'm trying to reach you about your car's warranty" call level yet, but it's getting there.

 

[Sanman]

Pre-auth and billing issues with insurance companies is one of the big reasons I moved to the VA. I still have PTSD from all the phone calls, faxes, etc. Downside of being part of a high volume provider group that accepted all insurances. Medicare was much easier to manage. Never dealing with all that again.

 

[Therapist4Chnge]

Pre-auth and billing issues with insurance companies is one of the big reasons I moved to the VA. I still have PTSD from all the phone calls, faxes, etc. Downside of being part of a high volume provider group that accepted all insurances. Medicare was much easier to manage. Never dealing with all that again.

Those "(Dis)-Advantage" contracts are such a PITA to navigate. I'm on some list-servs and the majority of billing problems seem to come from them. I decided to not see any Medicare patients because I didn't want the hassle. I know this isn't possible for some/a lot, but the time suck was evident from all of the complaints I've seen over the years.

 

[Sanman]

Those "(Dis)-Advantage" contracts are such a PITA to navigate. I'm on some list-servs and the majority of billing problems seem to come from them. I decided to not see any Medicare patients because I didn't want the hassle. I know this is possible for some/a lot, but the time suck was evident from all of the complaints I've seen over the years.

Yup, makes VA red tape seem worth it. Once they became ubiquitous for us and I was getting 40+ calls a day for our clinicians, it really made the alternative look good. I still remember sitting on an audit/auth for Optum medicare advantage where I had 3 90832s billed out they didn't pay. Wasted 2 hours on the phone with two different auditors. Gave them the MMSE/MOCA score from intake 4 months prior and they wanted me to go back and get an updated MMSE to ensure the client was still capable of participating. I asked them if they were paying me for that as they had not paid the bill for anything else yet....crickets. Then I realized I was on salary and just didn't care anymore.

 

[WisNeuro]

Pre-auth and billing issues with a number of Medicare (Dis-)Advantage Plans was a large part of the reason I jumped to the VA when I did. It was not uncommon for me to spend more of my time in day dealing with insurance requests than seeing patients towards the end of my tenure. I remember getting 40+ claim review and pre-auth calls a day for my people at one point. Downside of being part of a high volume provider group that accepted all insurances. Medicare was much easier to manage. Never dealing with all that again.

Yeah, I only deal with certain insurers for my clinical stuff. Though, medicare with BCBS supplemental actually doesn't pay all that bad for a dementia eval, and fairly easy to deal with.