Don’t Get Bullied

Mike Rothschild, OD

When mail comes from an insurance company, I expect it will be a check and checks make me happy. But when it is something else, it always seems to be something that makes me unhappy. I have found that “news” from a third party payer is rarely good.

In recent months, some insurance companies have been sharing some news with me that I, at first, thought was good. They let me know that compared to “other physicians within my specialty,” I bill at a higher level. This is good to know. I feel like we deliver high quality care and accept a lot of complex cases. We are diligent, we work hard and here’s proof that we do it better than others.

But the letter was not to congratulate me on my diligent care, it was to threaten me. The letter went on to say that they are going to keep watching and if I don’t fall in line with everyone else, they might be forced to investigate. They then said that this investigation would be disruptive to my business and if they catch me doing wrong, I would be in big trouble.

We work hard to make sure that we are billing appropriately. We take classes, read updates, and use software within our EHR to ensure that our coding is correctly done. We don’t do unnecessary tests, we incorporate testing protocols and we do what is right for the patient, every time.

Here is the journey through my reaction to this bullying letter:

Pride “Thanks insurance company for acknowledging our excellent work.”

Disappointment “Hey, you’re not being cool about this.”

Fear “I don’t want my business disrupted or to be punished.”

Doubt “Maybe we should start billing with lower codes?”

Awakening “Hey, wait a minute, they are just trying to scare me, and it worked.”

Anger “I am from the South and I will whip your ass, bully insurance company.”

Realization “This is just an intentional, controlled tactic to reduce their expenses.”

Defiance “They are not going to scare me into breaking the rules for their benefit.”

Self – Confidence “We work hard to do it the right way and we do it well.”

Dedication “Let’s use this as an opportunity to stress to the team the importance of billing.”

Commitment “We will stay focused on doing it well with the partners we have in place.”

Welcoming “Come sip some sweet tea while you investigate all you want. Sorry about #6.”

The lesson is this: Don’t back down just because a bully comes knocking. Do be ready to stand up to him by making sure you can back up your billing with solid documentation. Bullies are less scary when you are ready to stand up to them – just be ready.

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