denisenewkirk
Member
Posts: 191
Joined: Mar 2003
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Tuesday March 11, 2008 10:30 AM
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BC has entered the bill review market. In the past year, SCIF, Berkshire Hathaway and other carriers have contracted with BC to provide bill review services. BC is singlehandedly burying the last of the stalwart wc providers. The number of errors they make in bill review is astronomical. These are not denials for lack of authorization or other "arguable" differences. Instead, they are a comedy of errors such as placing the "allowed amount" in the "PPO reduction" column of their EOR and paying nothing as a result. For providers who provide more than one procedure on a single date of service, BC seems incapable of reading past the first procedure listed in the report and will not pay on any of the others stating they are lacking documentation (when, of course, all procedures are reported, just not in the first paragraph). What is burying providers, in addition to having to wait for payment, is the time and expense required to deal with these erroneous denials. In order to counter BC's mishandling, a provider has to write a letter to the carrier explaining the issue, photocopy the bill and report and incur the expense of mailing it a second time. While this usually results in payment, carriers DO NOT pay increase and interest when the payment is beyond statute deadlines even though the delay was clearly their mistake. Of course, oftentimes BC compounds the error upon the second review and writes back and says they paid according to fee schedule when, in fact, they paid nothing. Negligence is definitely ocurring here, whether with criminal intent (fraud) or not, I do not know. I will be submitting another whole round of Audit Unit complaints, which is time consuming and costly too.
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Denise
Medical Biller
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