Santa Clara County Deletes Provider's Bills
The County of Santa Clara, a public self-insured employer, employed an odd tactic to resolve bills it had trouble processing: reportedly, they simply deleted the bills.
daisyBill’s routine monitoring of a new client’s billing revealed several bills for which Santa Clara failed to return Explanations of Review (EORs) on time. Upon investigation, daisyBill discovered the surprising reason for the missing EORs.
Santa Clara’s clearinghouse vendor reported that the provider was not on file in Santa Clara's system. To remedy this, Santa Clara reported it requested a W-9 form from the provider. But after 10 days without a response to the request, Santa Clara simply made the bills disappear.
Missing e-EORs Raise Red Flag
For the first several weeks of a new daisyBill client’s account, our team checks the client’s bills to ensure everything goes smoothly. With daisyBill processing almost 2.5 million workers’ comp bills annually, these standard new-client checks rarely reveal any problems.
However, Santa Clara reminded us why we conduct this routine monitoring.
Since several e-bills were missing payment and e-EORs after the mandatory 15-day deadline, a daisyBill representative contacted Santa Clara’s bill review, which reported that the e-bills in question were not on file.
From there, daisyBill reached out to Santa Clara’s clearinghouse, which promptly investigated and reported back to daisyBill (emphasis added):
“The provider wasn't on file, so [Santa Clara] sent a W-9 request to the provider on 3/7. Since they did not receive a response back within 10 days, they deleted the bills.”
daisyBill alerted the client, who immediately sent their W-9 to Santa Clara. daisyBill then resubmitted the bills to Santa Clara for payment.
No Consequences, No Compliance
(Obviously), by deleting the client’s bills, Santa Clara failed to adhere to multiple California billing mandates.
The good news for Santa Clara is that there will likely be no regulatory consequences because California will always honor the claims administrator’s mantra: Heads, I win. Tails, you lose.
The lesson we take from this tale is to continue monitoring new clients’ accounts. Claims administrators will inevitably bend, break, or disregard the rules — because no one is stopping them.
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Unbelievable! No medical ethics whatsoever. This is absolutely appalling.
I wonder if Santa Clara County warned the medical provider that if a response is not received within 10 days they will throw out the bill. If not, shame on the county. But If warning was provided then whose fault is it when the bill is thrown out when a timely response is not received? I personally do not agree that any bill should be thrown out and that 10 days is insufficient time to comply, but we all have to work together.
California regulations require Santa Clara County to issue an EOR denying the bills. Further, the regulations require that the EOR explains the reason for the denial. Appropriately responding to bills with EORs means that the individual responsible for the billing receives the denial and can take the necessary steps to respond to the request and submit any missing information or documents.
Letters requesting a W-9 without the context of the bill are often misrouted, thrown away, or ignored by the administrative staff that opens the practice's mail. However, all administrative staff are trained to properly route EORs. Furthermore, there is no proof Santa Clara requested the W-9; an EOR would offer such proof.
Daisybill is extremely biased against insurance companies. Their "news" copies Fox News, MSNBC, and the National Inquirer. All false propaganda. They will eventually report that insurance companies are in cahoots with Bigfoot, Grey Aliens, and Elvis Presley from beyond the grave to avoid paying bills. Take what they say with a grain of salt.