What is a medical billing negotiator?

Answer 1

An individual or firm may be employed, usually by the insurance company who pays medical bills, to contact the healthcare providers and negotiate a reduction in their bill. Providers can range from doctors and hospitals to labs, therapists, equipment and medications-anything connected to medical care. No specific training is required but a medical background or medical office experience is helpful to determine whether the bill is accurate. It can be painstaking work to review medical bills as they contain codes for procedures and other detailed information. Some bills contain overcharges under the established rates, some are double charges or simply coded improperly. Some attorneys use bililng negotiators to reduce their client's need to pay off the entire bill after a settlement or litigation award. Almost all insurers will negotiate. Even the Federal government, as payors of Medicare and Medicaid, have to pay attention when there may be a mistake in the bill, which is unfortunately quite common. The range of reduction varies but reports of up to 70% reduction have been made. The average reduction is more likely in the 10-25% range. The negotiator will typically keep a percentage of the reductions, depending on the type and volume of billing business he or she gets, this fee can range from 5-40%. The negotiator must be persistent and have facts to back them up. It also helps to be authorized and prepared to offer bill payment in full at the conclusion of the negotiations.