The Biller "Du Jour"

by Insurance Guru

Biller "du jour" -- I've been using this term for nearly 20 years to describe a phenomena that faces all claims examiners. You know how you ask for the "soup du jour"? Well, medical billers tend to stay just as long on the menu. They've got a tough job with low pay... so chances are that the biller you're dealing with is new on the job and under-trained. Since Insurance Companies and Providers interact in a kind of "delicate dance", a lightly trained rear behind the biller's desk could be courting catastrophe.

Here's an example: Biller Du Jour sends us a bill for an established patient visit for a yearly physical. Fine -- the diagnosis and office codes all check out, but then they tell us that these services happened at a surgery center. We have to deny that and send it back. A claim is a legal document -- we can't just have a chuckle and fix it. Well, we do chuckle.

The claim that still cracks me up is a physician inpatient visit. No problemo -- everything checks out except for the hemocult that was billed. Inpatient? Really, a hemocult is a card with some circles on it. You take it home and put some of your poo on the circles and mail it to the lab. My brain had a really good time trying to figure out what the doctor could possibly do in a hospital to get paid for that. (Insert Mission Impossible theme here) -- Dr. No stealthily visits patient X in the hospital, gloves up, checks for spies and quickly gets a poo sample. Dr. No slides the hemocult card out of his pocket, expertly applies poo to the circles, zips up the sample and it's back into his pocket and off he goes for a shaken, not stirred martini. Not. Gonna. Happen.

We all run into a Mr. or Ms. Du Jour -- probably on a daily basis ... The customer service rep on the phone, the "expert" computer person at Best Buy or the "top-notch" office staff at your PCP's office. Unfortunately ,in the insurance industry, it just creates denied claims and very unhappy patients. Your Insurance Company can't do anything about it short of telling the biller how to bill. Which is... Not. Gonna. Happen.

My apologies to past, current and future medical billers.... it's a tough way to earn a living.