Medical-Billing - v_SVMC

Salinas Valley Medical Clinic - Docs (Swan and Inlow), X-Ray, and MRI Imaging

First and foremost, I need to be very clear here. These are Orthopedic Surgeons and their office services including Xrays and MRIs.

All of these people have treated me incredibly well.

Dr. Swan has now performed 7 outpatient procedures on me and Dr. Inlow has performed one. Both are really great at what they do. Their entire office staff, which is large, has a very good energy about them. They hold smiles and they treat people well and with respect from what I've seen.

In this initial bill review from 12/2018 through 7/2019 they generally billed appropriately for services rendered. I had a lot of appointments that had 20-40 min face time. There was a lot of trouble shooting going on. I do know of two very short appointments that got build out as if they were in the 40-50 minute range, so in that sense there may be some minor over billing on two out of 19 office visits for for E and M codes. One was a pre-op appointment that was very fast. If they are supposed to get credit for surgery scheduling and such under a pre-op appt, that makes sense...

HOWEVER... as it turned out, between December 2018 and July 2019 I only saw billing line items for 7 of 19 office visits?!!? YIKES...

Summary

I had copays due with (almost) every visit. If the copay satisfied the EOB reconciliation, the visit itself never showed up on a billing statement?!

What happens if I paid a copay that was not required (which happened in $100 increments twice...). How do I figure out what they did with my money?

Turns out it was impossible to reconcile without asking for reports from the clinic.
When I asked, I expected to get a summary report.
Instead, I got 22 pages of documents that I had to compile to try to figure out what happened to my over payments and to figure out where odd and strange adjustments were coming from, which now seem to mostly be related to these corrections...
After a few short visits with the office admin to get print outs and 6 hours of futzing, I got within $75 or so of being reconciled.
No major or intentional crooked stuff here.
None was expected from this group, but it would have been impossible to know without 6-8 hours of futzing.
And if you've seen the other sections on this site, and realized that sometimes billers intentionally do things they shouldn't, working on blind trust in this area these days is not a suggested option.

COULD YOU HAVE WORKED YOUR WAY THROUGH THIS VERY COMPLEX BOOKKEEPING PROBLEM?

Is this the type of thing we should be paying $1000/month for the opportunity to pay more to experience when we actually need care?
Simply put. NO.

No disrespect meant to any/all of my doctors and those working in these offices and those doing this across our country, but your "trade" is only part of the "business" and ultimately, we either need doctors who want to be "business owners", taking responsibility for all aspects of the commercial experience, including reasonable and auditable billing OR we need a dramatically different system in which doctors do what they do, and there is a universal billing / financial reconciliation system that is not subject to massive billing manipulation and confusion as is the case currently.

This idea of providing the trade and turning the billing portion over to folks who are going to make minimal margins for a lot of confusing work only leads to burning people out and encouraging them to cheat to make up for the mind numbing hard work that the business owners aren't allocating enough money to do...
With Medicare for all, most of this disappears. There would still be billing and reconciliation, but the transparency would be forced by the government and the rules for all locations would be the same , and the idea that private 3rd party billers could hijack business billing for their benefit ends. And.. and... and..

Bills

Bill Dated 2/27/2019 -- It's got the Doctor's Visits okay. It has a mysterious $60 payment applied that I did not make. It's missing all references to MRI Billing for January and early February and it seems to be missing co-payments for the office visits. (12/20||1/9,29||2/11)

Bill Dated 3/20/2019 -- It's only got one additional Doctor's visit on it as compared to 2/27 and the EOB for that is not back. Still no sign of billing for the MRIs and there are two new patient payments ($30 and $15) registered that I did not make...(1/9,29||2/11,27)

Bill Dated 7/9/2019 -- It's got two new visits on it. They are MRI Visits, and none of the first five MRI visits have shown up on any of the prior bills?! There is also a $15 credit for payment here that is mysterious, and there is no credit for the $30 over payment I made on Bill #2. (2/27||5/9,15)

Bill Dated 8/13/2019 -- This is nearly identical to the 7/9/2019 bill except for the watermark saying my "account is past due"...(2/27||5/9,15)

OOPPSS.. Between December 2018 and July 2019, I had 19 office visits at SVMC.

The invoices from SVMC only show a total of 7 office visits...(12/20 // 1/9,29 // 2/11,27 // 5/9,15) ?!?!

YIKES... how am I ever going to audit this...

This is not the financially manipulative move it could be, but it does make it fully impossible to audit the office by a mile...

Their system does NOT show an office visit if the balance due is ZERO. So when I made a copay, and the insurance came back with only the copay due, that does NOT show up on their office billing.

The problem with this? If I overpay with a copay, I have no way to see the adjustments and corrections and that's where a lot of the mystery adjusting was coming from, and it seems I may have lost some money in the process, but we'll see...

Untangling the Adjustment mess and some other stuff..

Just before the third bill arrived, I was in the office and I asked for a print out of all my office visits, co-payments and insurance adjustments. To my surprise, they had to print out office visits by practitioner or office (MRI as a separate practitioner). Then, they had to print off each invoice in non-invoice form to see copays, payments and adjustments. (no list based reporting). And as I expected, their copay system was not directly tied to their billing system, so that is a place for things to get lost, although it seems they did an okay job of manually transferring items.

In general, their billing software just really sucks, their lack of any system for printing monthly statements showing all activity leaves customers in the dark, and when they print bills, the bills only show items with open balances. If they had an item that was overpaid, the patient would never see that and the patient doesn't see any adjustments made to re-allocate that money elsewhere other than random assignments.

In the sole proprietor office I manage, we quit accepting copays upfront in our office, as tracking the partial payment and making adjustments when the insurance company threw a curve was harder than just collecting everything after the fact, and this office is hitting those same issues.

List of office visits from Dec 2018 through July 8 2019 - 3 pages

Detailed Invoices from Dec 2018 through July 8 2019 showing copays and adjustments (kind of) - 19 pages

In order to try to track this, I had to build a snazzy google sheet, and about 3-4 hours of wasted time later, i got close to getting things reconciled.

MRIs done on the same day are only subject to a single $100 imaging fee.

On two occasions, they had collected 100 each as copays AND they had allocated them to a single line item both times.
This is where adjusting for over collection of copays fully nullifies any benefits of collecting copays.
I can't fully reconcile where they shifted my payments but I got close.
They unallocated one in a $40 and $60 qty.
They allocated the $60 to the first open visit in December and they later allocated 15 of the $40 to a visit much later.
The other 100 got easily allocated to a future MRI where they didn't collect the copay.
At this point, I'm only out $25.
HOWEVER, bill #1 shows they allocated another $30 to the 12/20 visit date that does not show in the digital printout... and since I over paid that bill that is all confusing.
I will also say there is a zero invoice bill in the packet for $25 where they then un-allocated a 25 fee as some kind of fancy adjustment. Also, I paid $25 in on another invoice for a copy of a few medical records they never delivered in the office. How deep into the small stuff should I really tread?? Not this deep...

Summary

IN TOTAL ON THIS CASE, I WASTED ABOUT 6 HOURS OF TIME DOCUMENTING THINGS TO FIND OUT WE ARE LIKELY WITHIN $50 TO $75 OF BEING SQUARE. BUT THE ONLY WAY TO KNOW THAT WAS TO WASTE THE TIME AND I'M OKAY FOR BEING OFF THAT MUCH. A LOT OF PEOPLE WOULD FREAK OUT...

HOW MANY OF YOU HAVE THIS TIME TO WASTE? HOW MANY OF YOU HAVE THE SKILLS IT WOULD HAVE TAKEN TO DO THIS?

AND WE EXPECT ALL US CITIZENS (OR THE FAUX GOVERNMENT WE PAY INTO) TO PAY HUGE MONEY TO PARTICIPATE IN THIS TYPE OF IMPOSSIBLE ACCOUNTING SYSTEM???

TIME FOR CHANGE.

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