I work in a small doctor's office and use an outside biller and I'm not sure if it's fraud or sloppy bookkeeping, but we do not understand the invoices and it seems that the doctor works so much, but sees very little income for all the work he does. All the checks from the insurance companies go to the biller's office. What questions should we be asking?

Who does the actual coding and setting the bill. You should know the charges you are asking the patient for, and you should know the gross about the company is suppose to bill.

So what percent of that money are they billing for you.

You need to have a outside audit of their firm to be sure and then do at least a annual audit of them after that.

Patient A comes into the office, he has a office call ( lets say 75 dollars) ,
So on that, patient what is the payment.

I give the procedure code and diagnosis code and I also let him know if the copay was paid then he bills the insurance companies or medicare.

I don't know what you mean by "very little income." But also keep in mind that insurance companies never pay the full amount, and of course the billing company is getting their cut. I was just recently speaking to my own doctor about this -- I was asking his opinion of this health care bill -- and he started telling me about this, that and the other thing that the insurance company dumps off, blah, blah. (I'm self-pay, and he charges me less, and actually gets more out of me for it -- we both make out better.)

You also have to understand that medical billing is one of THE most incompetent businesses I think I've ever seen in my life. I'm not quite sure they are competent enough to be fraudulent. I could quite easily believe they are screwing up. If you don't understand the invoices ask them to explain. If they can't -- well, if you go through enough people you'll eventually find someone who can. If you can at least understand the invoices, then you can check them yourself.

Having dealt with these people and knowing the amount of money they waste (meaning including yours), it might be well worth it to just pay someone to do it in-office. I recently had a lousy $35 bill, but I went around and around with them so much over it, I swear they wasted more employee time on the phone with me, not to mention the loss of cash flow since it didn't get paid for almost a year -- all entirely their fault. Between that sort of waste and needing to audit them, I have to wonder if it's worth it.

Thank you so much. I believe you confirmed what we have been thinking all along that it is simply incompetency.

:-) That gave me a good chuckle.