Is Medical Billing Leaving Your Operation Financially Sick?

Billing is an essential part of any medical practice. It is also a time-consuming, complex aspect of the business side of the organization.

Two of the major issues are patients that don’t pay and medical fraud.

To keep the clinic, hospital or doctor office operating successfully, these problems must be dealt with and prevented.


Medical Billing Fraud

Fraud can happen in many different stages.

It can begin with the patient who is attempting to claim payment for services that were never rendered or on another person’s claim.

It can also happen in-house with a staff member inflating the cost of services provided when filing claims with insurance companies.


Preventing these issues requires diligence on the part of the organization.

Procedures must be put in place that allow supervision and review by multiple people to lessen the chances that inaccurate information is filed.

Many times, separating the process of billing into multiple steps and assigning those steps to various employees provides a checks and balance type of system that prevents the problem in the first place.


Patients Who Don’t Pay

Dealing with patients who don’t pay their medical bills is a far more prevalent problem for clinics, doctors’ offices and hospitals.

You have two different scenarios to deal with.

In the first one, your problem patient is a person that you see regularly. While payment may be delayed from one time to the next visit, you can generally expect to receive what is owed.

In the second scenario, you have a patient that you won’t see again. This bill will be much more difficult to collect.

If you have policies in place ahead of time, you can reduce the amount of outstanding bills you must deal with.

Make sure you:

  • Determine how long you will hold an outstanding bill before turning it over to collections
  • Determine if you will add a fee for nonpayment
  • Decide if the practice will see the patient who has an outstanding bill


Know the Guidelines

Medical care facilities must also follow legal guidelines when refusing care to patients who cannot pay. In addition, they may have restrictions or obligations to be in compliance with the insurance provider.

It is important to ensure that all of the staff responsible for billing and payment know what these rules and regulations are.

As the article, “Where Does Your Practice Fall on the Medical Billing Risk Matrix” states, it is important to know where you are at risk.

You can request payment of all co-pays upfront before the patient is seen. It reduces the likelihood that the patient will forget when the bill comes to them later.

For those who say they can’t pay, especially for co-pays on larger procedures, you may want to set up a payment plan.

Sometimes the overall total can seem overwhelming to a patient and cause they to do nothing. Breaking it down into two, three, six months or even a year can make it seem more manageable.


Dealing with outstanding bills that don’t get paid is just one aspect of a medical facility’s business. While caring for patients must be the primary concern, the facility must receive payment to continue in business.

While it isn’t always easy or pleasant, billing is essential for the facility to provide the quality care that is needed.


About the Author: Joyce Morse is an author who writes on a variety of topics, including business and finance.



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