Yeah, getting a straight answer from the billing department even for providers is super frustrating. A lot of it is because hospital networks and private insurance companies have secretive reimbursement contracts that they don’t want providers or patients to have access too.
Yeah, same thing here. A good practice is to write the date and time of the call, who you’re speaking to, and the calls reference number. I will usually summarize what we discuss and then repeat the information back to them.
If you have all that information you can usually hold them to what they told you.
Well, I know in my hospital the first step would be to complain to the clinic manager. They can usually act as a go between for you and the billing department.
If that doesn’t work, pretty much every hospital has some kind of patient advocacy department. Ours is a third party called the Joint Commission for Quality and Ethics, they actually do it for a lot of hospital networks. You could register a complaint to them and back it by saying you plan to register a complaint directly to CMS if it’s not resolved. Even if you don’t have Medicare, if the hospital accepts Medicare they have to follow CMS Guidelines, which include protection concerning accurate billing.
This will make the alarms go off and probably cause an internal face to face meeting between the provider, management, and the billing department. So it’s kind of a big gun to reach for if your problem isn’t very large.
Oof, a little harder to deal with. There are a lot of sketchy nursing homes out there and they seem to be regulated at a much lower frequency.
There are supposed to be long term residency protections guaranteed through CMS as well, and there’s supposed to be state regulation. In my experience since you’re dealing with residency as opposed to short term care the rules can get a little more open to interpretation.
So it would depend on your individual situation. I would check the CMS residency right page and see if what you’re dealing with is easily interpreted as a violation. Every state is also supposed to have a free Long-Term Care Ombudsman Program that is supposed to provide families and residents help with resolving complaints, provide advocacy and sometimes financial help.
Hope this helps, I hate dealing with nursing homes. It’s another dark corner of American healthcare that shouldn’t exist.
Yeah, getting a straight answer from the billing department even for providers is super frustrating. A lot of it is because hospital networks and private insurance companies have secretive reimbursement contracts that they don’t want providers or patients to have access too.
It’s not just getting a straight answer, its getting the same answer twice from the same person that seems to be too hard.
Yeah, same thing here. A good practice is to write the date and time of the call, who you’re speaking to, and the calls reference number. I will usually summarize what we discuss and then repeat the information back to them.
If you have all that information you can usually hold them to what they told you.
That’s what we have to do. Even then they play stupid.
Well, I know in my hospital the first step would be to complain to the clinic manager. They can usually act as a go between for you and the billing department.
If that doesn’t work, pretty much every hospital has some kind of patient advocacy department. Ours is a third party called the Joint Commission for Quality and Ethics, they actually do it for a lot of hospital networks. You could register a complaint to them and back it by saying you plan to register a complaint directly to CMS if it’s not resolved. Even if you don’t have Medicare, if the hospital accepts Medicare they have to follow CMS Guidelines, which include protection concerning accurate billing.
This will make the alarms go off and probably cause an internal face to face meeting between the provider, management, and the billing department. So it’s kind of a big gun to reach for if your problem isn’t very large.
And if you’re dealing with a nursing home instead of a hospital?
Oof, a little harder to deal with. There are a lot of sketchy nursing homes out there and they seem to be regulated at a much lower frequency.
There are supposed to be long term residency protections guaranteed through CMS as well, and there’s supposed to be state regulation. In my experience since you’re dealing with residency as opposed to short term care the rules can get a little more open to interpretation.
So it would depend on your individual situation. I would check the CMS residency right page and see if what you’re dealing with is easily interpreted as a violation. Every state is also supposed to have a free Long-Term Care Ombudsman Program that is supposed to provide families and residents help with resolving complaints, provide advocacy and sometimes financial help.
Hope this helps, I hate dealing with nursing homes. It’s another dark corner of American healthcare that shouldn’t exist.