Postiys Portion Cut Meat

I reviewed the response made by the business in reference to complaint ID [redacted] , and find the resolution is satisfactory to me Regards, [redacted]

I reviewed the response made by the business in reference to complaint ID [redacted] , and find the resolution is satisfactory to me

The account was billed using the diagnosis code from the doctor's order for the xrays that the patient had done.? A second set of orders was found for the lab work that contained another diagnosis code for a routine physical.? Our coding department was able to add this code to the account and it has now been rebilled to the insurance.? The account has been removed from collections and the patient will receive a new statement once her insurance has had an opportunity to reconsider payment on the claim

A review of this account was done by our coding department and they determined that the screening code for this visit was added as the admitting reason, but incidentally, not carried over into the list of diagnosis that are put on the insurance claim. The screening diagnosis code
was added to the list of other medical diagnosis codes on the account. This correction was made and rebilled on 4/20/18. The insurance payer has not yet responded with how they intend to reprocess this claim.This concern was an isolated incident and not a representation of business practices. Education has been provided to the original coder to ensure further errors are not made in the future. If someone comes in for a screening and a medical finding is documented, i.elow bone mass, lump in breast, etc, then these medical diagnosis are recorded on the visit. Some insurance payers will skip over the screening codes and apply diagnostic benefits instead if there is a finding during a visit. This varies from payer to payer. Additionally, if a patient comes in for a screening and then is asked to return for additional testing, the 2nd set of testing will be considered diagnostic. It appears that some of the information provided by our associates regarding standard business practices may have been misinterpreted. Mount Carmel does not switch any account from preventative to diagnostic. Claims are simply coded based on the physicians order and in accordance with the imaging, lab, and operative medical reports dictated by the physicians

The request to bill the secondary UHC policy was initiated by our office back on 6/2/2016. After reviewing with our claims manager, it appears that the process may have been initiated but not fully completed and the claim may have been closed prematurely. The claims manager has sent
another request to have the secondary UHC policy billed. It will take 30-days until we receive a response from UHC in order to determine how it will be handled. The Director of our Customer Service/Collections department (*** ***) contacted the patients mother (*** ***) and explained this on 6/1/

I reviewed the response made by the business in reference to complaint ID ***, and find the proposed resolution to be satisfactory to me if it is carried out as described

The patient contacted our office on 6/5/and requested an explanation of the three bills: Hospital, ER Physician, and Radiology Inc. It was already explained that the ER physicians do not work for the hospital so the only way they get paid for services is to bill
separately. While ER physicians perform a 'soft read' of imaging they do not specialize in the reading and interpreting of these images. Radiology Inc is used to ensure all imaging is interpreted by specialists and detailed reports are created to provide the physicians with the proper information to decide on treatment plans. They also do not work for the hospital, therefore they bill separately.The patient questioned the ER level charges and it was sent for a formal review to the ER Management Team. It was confirmed that a level is appropriate for patients that arrive with a chief complaint of abdominal pain paired with special imaging and lab work. These levels are determined by ESI software based on national standards of care. ER levels are not based on length of time in the hospital or the outcome of care. They are the average operational costs associated with the evaluation and determination of medical treatment. The costs for ER levels are pre-determined for the hospital. Ohio hospitals publish their standard costs on the web. Mount Carmel's standard prices can be found at http://www.mountcarmelhealth.com/pricing-informationThe balance left for the patient is based on the contracted rates determined by the her benefit plan with Anthem. Anthem applied $to her deductible and $to coinsurance. These are the rates that Anthem felt were appropriate for the care provided and are expected of the policy holder to pay as their cost share portion.We spoke with Mrs*** today 6/26/and went over all the details. She was still disappointed but understood all of the explanations and that the 25% was the best offer we could provide other than a payment plan. She opted to take advantage of the offer and paid for service. The settlement was paid in two installments: $on HSA and $on AMEX. I sent adjustment for $to be written off the account and advised that the balance should be showing zero by 6/29/

I reviewed the response made by the business in reference to complaint ID ***, and find the resolution is satisfactory to me
Regards, *** ***

This complaint was addressed by our Mount Carmel Physician Billing Department. The manager of this area contacted the patient on 10/15/and he was satisfied with the resolution. Below is a summary of their research:
The payment that the patient is referring to is check #
for
$20.00, that payment posted to date of service 4/20/(Dr*** at MCMG
Diley Ridge)instead of date of service 4/27/(Dr*** at MC Columbus
Cardiology) as he requestedThe $that we are currently billing the
patient for is an accurate balanceThe proof of the $payment posting to
date of service 4/20/is noted on statement dated 8/23/15. The patients current statement balance is $40.00; $for
date of service 4/27/and $for date of service 7/21/15. The payment was posted to the oldest date of
service, we do that to keep the patient current

This has been resolved. I contacted *** *** to review the outcome of my findings. Here is a summary of the review:Baby's father's UHC was billed and paid 5/6/16. We were not provided with UHC secondary until 6/2/16. Our system indicates that a request to generate a claim was processed on 6/3/16.The account went into a holding pattern with the belief that UHC secondary had the claim. After investigating, it was found that our system did not produce the claim as it shouldThis was not discovered until 3/16/17. After this time, UHC provided feedback to *** that the baby would have been covered for the first days. This was contrary to what the UHC claims department told MCHS each time we called.After further investigation, it was clarified that a baby is only automatically covered when the policy holder is the biological mother/father. Since the policy holder is the grandmother, this automatic coverage rule does not apply. Both *** and *** were provided with misleading and incomplete info from UHC. Since the baby was never added by *** to the policy, there was no coverage. Additionally, all of the letters and correspondence we received was listed under *** instead of *** since UHC did not acknowledge *** as being covered. This is again why UHC provided misleading and inaccurate information about never receiving a claim.We do have the authorization to bill the pts mother for the balance left by the primary UHC policy since the baby was not added and UHC would not have processed the claim as secondary even if the claim had gone to them back in 6/2016. Additionally, UHC sent the policy holder *** *** letters requesting additional information to support processing the claim which UHC indicates was not responded to. All of the information above was validated with *** *** at UHC, ###-###-####, Ref# ***However, we have elected to allow an untimely billing adjustment to be used due to the acknowledgement that our system did experience an error back in 6/that prevented a claim from releasing when expected. At this time we are not holding *** liable for the balance based on all of these circumstances. We have contacted *** and informed her of our decision to waive the balance given the nature of these circumstances

Account Number: *** (Hospital Bill) - This account was billed correctly. *** did not deny this claim. They paid and applied $to the deductible and $to the coinsurance. Account Number: *** (Physician Bill) - This account was also billed
correctly. *** did not deny the claim. They applied the out of pocket to the patients deductible / coinsurance. Account Number: *** (Lab Bill) - This account for was billed with the same policy number as the hospital and physician bill. It does appear that the pts group number did change in from *** to ***. *** should not have denied this claim for this account since the patient did have active coverage. *** (Lab Billing Company) is following up with *** to get them to reconsider the claim since it was billed with an active policy number. They will point out that the policy was active and *** should have paid on the claim. All of the accounts that we have on file have been provided with the patients old insurance card. In order to avoid any further issues, the patient will need to ensure that they provider the healthcare provider with their most recent card that shows any changes to their group# or policy information.

I am still having issues with Mt CarmelThey are trying to send me to collections over a claim they did not submit in timeThe claim was submitted through my husbands insurance and then when I was first contacted by Mt Carmel, I gave them additional insurance informationThey chose to not bill it correctly and wait around until they received a timely filing notice from UHCI have a copy of this letter and so do theyI received a bill year after the birth of my childI have called numerous times to Mt Carmel, it seems we would get somewhere and I would have to explain the situation to a new person every timeThen I would receive a bill in the mail a few days laterAnd now a collections letterThis is ridiculousMy insurance company said they would pay for this service and Mt Carmel didn't even try to find out the proper way to bill and now they are trying to make me pay for something because they didn't file the claim in timeI know about medical billing and that is why I know that they can't do that, but I feel bad for all the other people they are scamming out of money because they don't know how to bill correctly and timelyPlease help!Thanks!

I reviewed the response made by the business in reference to complaint ID ***, and find the resolution is satisfactory to me

The account was billed using the diagnosis code from the doctor's order for the xrays that the patient had done.? A second set of orders was found for the lab work that contained another diagnosis code for a routine physical.? Our coding department was able to add this code to the account
and it has now been rebilled to the insurance.? The account has been removed from collections and the patient will receive a new statement once her insurance has had an opportunity to reconsider payment on the claim

? This patient was sent letters on 3/30/15, 4/10/15, 4/17/15, 4/27/15, 5/22/15, and 6/12/Each one of the letters indicated that the patient would need to contact us for a formal, agreed upon arrangementOur letters also included a settlement offer (currently expired) and a financial
assistance applicationMrs[redacted] did not respond to any of these lettersSending in random payments does not constitute a formal agreementThese payment plans are required to hold the account in good standingsOur system held the account in good faith, hoping that the patient would eventually pay in full or setup an arrangement with our officeShe did not, so as a result, her account went to collectionsWe will give this patient the option of setting up a payment plan with the collection agency or making an arrangement with our Healthfirst Financial Group; both who can extend her a payment plan beyond the day arrangements we have available at the hospitalIf Mrs[redacted] does not accept one of these offers, then her account will continue to be followed up on by the agency per our standard policies? I called the patient and advised that we will pull her account from collections as a one time courtesy since she agreed to setup a loan through Healthfirst Financial? The account has been recalled from agency and one of our collectors will set her up on a loan on 8/28/? The patient was satisfied with this result.?