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John Kelly

Clearly, medicine is business. Big business! Recently, the Florida Medical Association lobbying efforts and federal and state legislation have spoken clearly on this issue through the Managed Care Bill (SB1012), proposed Medicare reimbursement cuts, silent PPOs and assignment of benefits.

While attending local medical society and related medical association meetings, I have heard a recurring theme: rejected reimbursement claims from Medicare, Medicaid, PPOs, HMOs and others. I’ve listened to consultant after consultant emphatically encourage practice administrators and managers to work rejected claims every day, not to set them aside, to leverage state agencies, and to also fight this injustice. Recently, I learned that a local Central Florida practice had placed a large insurance carrier for collection!

So is this big business or monkey business? Personally, I’m nauseated by the behavior of insurance carriers kicking back valid claims. No doubt, no debate: patient and quality of care ultimately suffer because of it.

Beginning next month, Orlando Medical News will unveil a new regular feature: “Most Outrageous Rejected Claim of the Month.” Available in print and online, the feature will highlight claims that should never have been rejected.
Central Florida practice administrators and managers should email their Most Outrageous Rejected Claim and a brief explanation (550 words or less) to Mostoutrageous@orlandomedicalnews.com. We will select one each month and offer a comment by respected industry experts. Send in your story today!

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