Firms aim to help doctors with claims woes

For a fee, there are companies that offer to get doctors' money from insurers.

By Julie A. Jacob, AMNews staff. Feb. 11, 2002.

Chasing insurance companies to get paid isn't just a job for physicians anymore.

Physicians can hire companies that say they can unravel a medical group's knotty claims payment problems and help doctors get their payments from insurers.

For a fee -- usually a percentage of the claims paid or a flat fee of $275 per claim -- these firms will analyze delayed or denied claims and figure out why they weren't paid, and work with insurers to straighten out problems.

"We look for coding errors, documentation, missing information. ... There's a lot of different reasons why a claim is not paid," said Dianna Madar, vice president of IMD Healthcare in suburban Dallas.

A claim may be delayed or denied for something as simple as an incorrect code or old patient address, said Julian Pace, president of Medical Claim Relief LLC in Louisville, Ky. In other cases, computer problems are the cause. A practice administrator for a gastroenterology group hired Pace's firm to help it reconstruct its electronic claims after the group's computer system crashed.

"In our situation, it would have been impossible to stay current and focus on the old claims as well," said Debbie Cole, an administrator for Central Kentucky Gastroenterology in Lexington, Ky.

In other cases, Pace said, his company will discover more serious reasons for denied or delayed claims. For example, he said, his company discovered that a surgeon wasn't getting paid for some of his services because some patients were fraudulently using insurance cards. [...]