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Attention All Medicare Providers: Are You Using an Outsource Company?

Do you use an outsource company for your Medicare billing and account receivables? Do you know who is using your data? Do you know how they are using your data? How much is it costing you?

National Government Services, as your MAC, has experienced a large increase in unnecessary telephone calls from outsourced agencies representing our providers.

These calls are similar to robocalls asking for Medicare claim information from the MAC. The information has already been provided to the billing provider through the RA, our provider portal NGSConnex, or our IVR system. These types of calls do not result in additional payments for the provider and are simply used by the caller to obtain certification that they contacted the MAC, which in turn allows them to pass additional administrative costs onto you, the provider of service.

It’s important to be aware of who you are contracting with and how they’re using your patient’s medical information and your financial information, if billing you for unnecessary charges. Some have subcontracted the work out, and you may be unaware of who’s really doing the work. Here are some question that you should ask internally:

  • Do you know if your billing company uses an outsourced entity for any reason?
  • Do you use an outside agency to reconcile your accounts receivables?
  • How is the charge structure set up – do they charge you for the number of calls they make to an insurer? What’s the outcome you’d like to see from any calls made?

Finding the answers to these questions can help you determine if the services you’re paying for are legitimate and in the best interest of your patients.

You may want to research these potential unnecessary calls and expenses. Not only is this a financial burden on you, it increases our workload and prevents our PCC representatives from assisting you timely.

Legitimate inquiries include; complex questions to assist with getting payment on a claim, assistance with resolving claim issues that cannot be handled through self-service, and other issues that actually need human intervention from the PCC.

Inappropriate inquiries include; questions that don’t pertain to the provider’s actual claim but instead are generic scripted questions that are asked over and over with the same exact response each time, and questions that can easily be answered by reviewing the RA, using NGSConnex Portal, the IVR and/or our website.

All providers that participate in the Medicare program are responsible for ensuring that all PHI and PII is handled appropriately, as well as ensuring that the Medicare Trust Fund is protected. Abuse can impact not only your bottom line, but can also impact our Medicare beneficiaries. If we continue to see abuse of the PCC, we will implement actions to stop the abuse.

You can help by ensuring you know exactly what your billing agency is doing with your information, ensuring that they attend our educational events, and that they are not billing you for “work” that they have not actually done on your behalf.

Posted 9/19/2022