This question came up from a new employee this week, and I realized that it is something that others might have questions on too.
So, an F.I., or Fiscal Intermediary is company or entity that is contracted with an insurance company, or payer, to process claims.
For example, Medicare is a government payer. But you do not send your claims to the government. They contract with different companies (Blue Shield, Palmetto, Noridian, NHIC, etc.) to process all of their claims for them. there would be some compensation to the F.I. for their services, although I don't know (or really care) how much that is. Under their contract with the payer, they are obligated to ensure that all policies and regulations are adhered to exactly. If they do not, then they are subject to fines and other penalties.
Interestingly, some payers allow you a certain number of errors. Let's face it, nobody (or no company) is perfect. Mistakes will be made. It is how you handle those mistakes that shows the character and integrity of your company. The Payer (Medicare in this example) will allow you a certain percentage of your total claims to have inaccuracies on them. Let's say 6%. If your error rate goes over that, even if it is a true error, you are approaching what they consider fraud. They will also audit your books regularly, as the payer will also audit the F.I. to ensure accuracy. and quite frankly, in this day and age of spiraling healthcare costs and fraud, I, for one, do not mind dealing with auditors. If it means keeping my premiums down and giving my employer an A+ rating, I'll take the minor inconvenience of an audit.
So this, in a nutshell, is an F.I.
Author, Medical Billing, Coding, and Reimbursement
A medical billing professional for over 30 years now, I have seen a lot of changes in this field, and there are a lot more on the horizon. Follow me as we see what they mean and for who.