Bill Sample / December 7, 2018 / Wendy Gamble
Followup may take the form of a phone call to payer to discover a lost claim or to receive interpretation of denial message correction of earlier submitted data resubmission of the original claim consultation with the provider and medical notes or denial appeal. Both FPP and Denial rates are very important metrics often used for billing process improvement. The upside of FPP/Denial metric is that it is charge-invariant but its downside is that it hides the differences between process imperfections on the claim submission and claim payment sides. To identify patterns of problem CPT codes or payers FPP/Denial metric needs to be computed and compared across all pairs of payer-CPT code which is a standard feature for modern billing technologies.
The same can be said of a sample contract. If nothing bad ever happens the sample contract is fine. But if a problem occurs it may not work out so well. When starting your new business no one wants to think about things going wrong but unfortunately in this business things do go wrong and we all need to be covered by a comprehensive contract when this happens. It may not be anything you did wrong and it may not even be anything the provider did wrong but sometimes things happen that are beyond our control. If you do use a sample contract and then two years later find yourself in court with a former client you are going to wish you had looked into writing the contract a little more. Just having a contract doesnt cover it. You need to make sure the contract is very specific to your company.
Contracts are kind of like insurance you dont need them until theres a problem. But when there is a problem its a relief to have one. There are really a lot of areas that you need to make sure you are covered in and a contract is really the only way to do that. When starting a medical billing business there are many things to think about and writing a contract is just one of them. There are many expenses in getting started and most of us just starting out dont want to spend our limited investment money on an attorney. So what do many of us do? We "google" sample medical billing contract and use what we think sounds good and make up a contract for our business. That can be a big mistake. Thats what we did sixteen years ago when we started our business except there was no "Google" then.