Picture this: You're in the back office doing much needed paperwork, or just about to head into a treatment room for an appointment with a sick patient. The waiting area is busy — phones ringing and office staff looking already a little overwhelmed because you are short-handed. Then it hits. The door slamming, the yelling, the negativity in the air is so thick. You reluctantly poke your head around the corner and you have now caught the attention of the patient creating this ruckus.
There is Mr. Smith waving a handful of papers around your lobby area screeching at your front office staff, and now you, about a bill he has received. Saying words like, “insurance fraud” and “I'm calling Medicare and telling them to audit you!” You think, “Now what?” If you have a designated person to handle this and a written policy in place, you'll be fine and steps have already started to calm the situation. But if you don't, this person can cause doubt and damage to the rest of your patients if left unattended. Here are some steps you can take to remedy this situation immediately:
The first thing you will want to do is remove the upset patient from your lobby area. Find a treatment room or empty office with a door that will close. This won't eliminate the noise, but it will diffuse the words. You also will want to consider privacy laws that prevent you from speaking openly to any patient regarding their treatment or care.
Next, you will need to bring in your designated customer service person who handles patient complaints; if this is you — great. Now you're ready to go. Offer Mr. Smith some water. He's clearly upset and just the gesture will go a long way, give you both a moment to breathe, and allow you to now take control of the situation.
Listen. Let the patient have his say, and don't interrupt. Take notes. Most patients do not understand their insurance or what the ICD-9 or CPT codes mean. Deductibles and co-insurance are foreign words to them, as well. Insurance EOBs provide little to very confusing explanations to the patient about how to really read them. Once the patient has had his say, ask if you can now help solve the problem. It's amazing how a small gesture like asking will put the patient at ease. That's really all they want is an explanation anyway. Pull out the patient chart (most office are electronic now) and show him your chart notes and explain the process you went through. Elderly patients often don't even remember the appointment. Once they see what you are talking about, and why you had to use certain codes, they will most likely change their mind. Patients really do not understand the hoops that you have to jump through in order to be paid by the insurance companies. Code this way, add this modifier, don't use those two codes together, etc … Be sure to have an explanation of his insurance benefits in front of both of you, as well.
Now that Mr. Smith understands, walk him calmly back out to the lobby with a smile and thank him in front of your other patients for coming in and asking his questions. Be sure to say that you are more than happy to help explain anything to him, anytime.
You have just provided not only Mr. Smith with a very important experience, you shared your open-door policy with the rest of your patients. So instead of them going home and calling their friend, or spreading around their social media sites that you commit insurance fraud, they will be saying, “Wow! They have such great customer service!”
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