Complaint Review: USA medical partners-Oklahoma - Tulsa Oklahoma

The client who has filed this comment has falsely reported information in the details of the original report. 

It is absolutely unprofessional to have experienced the communication that has taken place via phone as well as email documentation with this client.  Placing my name in this complaint is the deformation of my character, as I personally have had a very successful and reputable reputation for the last 25 years running medical equipment company as well as a hospital revenue cycle. 

 I do in fact realize that we all have the right to freedom of speech, however, details listed with my personal name to falsely accuse is very unacceptable and a personal attack on top of the breach of contract that the client is bound by.

This billing company provided a list of contracted payors upon contract discussions and startup with our organization, we have 50++ direct contracts as well as several TPA that afford the utilization of additional contracts with many insurances across the US, as with anyone filing claims there are payors with closed markets or plans that a not networked that we are sometimes left with no option to file with the out of network benefits to a patients plan for services rendered prior to claim processing.

As a provider of services to patients it is your duty to have the knowledge and understanding of how insurance processes claim filings as well as the distinct medical policies that are associated with the items you are providing.  The billing service is not at fault for a personal lack of knowledge of claim processing and the many insurance companies' medical policies that are wrapped up in the adjudicating of claims.

Health insurance started in the US back in 1929, there have been many advancements over the course of the years.  In 1977 it was adopted to recognize the ICD system to accommodate advances in knowledge of diseases and diagnosis.  In 1983 the Center for Medicare and Medicaid Services adopted a CPT procedure coding system which became the standard, in 2000 the final rule was mandated that CPT, HCPCS, and modifiers.  Coverage determinations are made through LCDs and coverage medical policies from commercial payers and often have specific requirements to substantiate the medical necessity of an item or service being provided.  

Our billing service only provides the services that a client requests and contracts with us to provide services.  We only provide patient collections if a client has contracted to have our company if a client chooses for us to provide patient collections, same as payer collections the revenue is all accounted for by the client, not hidden.  

Billed charges, this is one of the most confusing aspects in the world of medical billing, not all payers have the same reimbursement rates for services or items provided.  Charge rates in a billing system is set at the higher highest contracted rate so that all contracts will reimburse accordingly, meaning if we were to only place a billed charge of 5.00 when our contracted reimbursement for a specific payor is 9.50, we would only be reimbursed at the charge rate and not obtain full contracted reimbursement. 

When a claim is filed, the charge rate has listed the payer does an immediate adjustment to reduce to the payer's internal reimbursement rates or "allowed charge" then paid out per the patient's plan specifications of co-insurance, deductible, covered and non-covered items.  Therefore understanding the cost structure rather than the lack of knowledge of this aspect of a business is not a sign of shady business, but just simply the methodology of building and setting up a software system for an organization!

In response to this, I am asking that my name be removed from this complaint as well as any other posted names since the client has a signed contract if you would like to express frustrations or personal thoughts you have the right to do so against the company name, not individuals.