A persistent glitch in Mitchell’s bill review service is causing revenue management chaos for providers. For second review appeals, providers receive electronic explanations of reviews (EORs) that mistakenly report duplicate payments.
For over a year, despite numerous and repeated requests from providers, their billing agents, and the affected insurers' clearinghouse, Mitchell has failed to correct this electronic EOR error.
The Year of Billing Dangerously
Since May 2018, providers have received incorrect EORs for thousands of Second Review appeals from multiple claims administrators, including Zurich, Guard Insurance, and Keenan.
These Second Review EORs report BOTH the amount allowed for the second review appeal and erroneously report the amount allowed for the original bill submission. This math error means an EOR incorrectly sums the two amounts and falsely reports a significant overpayment.
DaisyBill software makes such math discrepancies easy for our clients to notice and report to us for follow-up. Unfortunately, we are powerless to compel Mitchell or any of the affected claims administrators to fix their technology.
We cannot help but wonder how this Mitchell EOR error impacts the accounting for the Zurich, Guard Insurance, and Keenan employer clients. Does Mitchell report the correct payment amount to the employer clients and an incorrect payment amount only to providers? Or, perhaps Mitchell reports the incorrect inflated payment amounts to both employers and providers?
DaisyBill first reached out to Zurich to address this issue in May 2018, when multiple EORs reflected these miscalculations following second review appeal.
We contacted Zurich’s clearinghouse, with several examples of erroneous EORs. The clearinghouse traced the source of the problem to Zurich's bill review service, Mitchell. Other affected claims administrators noted above also utilize Mitchell bill review services.
Unfortunately, Mitchell’s efforts to correct the problem have failed. Reportedly, Mitchell developed and tested multiple fixes for this bug. However, Zurich and other claims administrators continue to return incorrect EORs when responding to second review appeals.
Mitchell’s apparent lack of urgency is another example of an infuriating syndrome in workers’ comp. When the ineptitude of claims administrators (or their agents) heaps inconvenience on providers, solving the problem ranks far too low on the former’s priority list. The result? Treating injured workers becomes tougher for providers, to the detriment of all concerned.
In the example below from our DaisyBill Billing Software,
- For the original payment, Zurich incorrectly remitted only $87.52 and the electronic EOR for the original bill reports this incorrect $87.52 payment.
- Zurich failed to pay CPT 90834
- The provider appealed the incorrect reimbursement
- For the second review, Zurich allowed an additional $105.00 for CPT 90834 as the check for the second review payment (pictured below) demonstrates
- Instead of reporting an additional payment of $105.00, the Second Review electronic EOR sent by Zurich incorrectly reports an additional payment of $192.52
With everything that can go wrong in workers’ comp billing and payment, providers need billing agents who know their stuff. DaisyBill makes billing easier, faster, and less complicated for providers. And when necessary, our Compliance Team gets involved on behalf of our clients. Schedule a free demonstration of our Billing Software below!