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Here are some of the questions that our members are able to ask us, along with our answers.
Question
Hi Alice ~ Good day!
I have 2 questions
#1
We have several physical therapy clinics which fall under the umbrella of one TIN number. One Medicare group number but the therapist are credentialed individually. The credentialing coordinator has gotten NPI for all clinic locations, however the billing for all clinics are done by one central office. Should these clinics be listed as sublets or can they fall under the 1 NPI which the company has? Also, could you please advise exactly what goes into Boxes 24 J, 32 A & B and in Box 33 A and B.
Thank you so much!
Deborah
Answer
Hi Debi,
You can get NPI numbers for each location, there is a place on the NPI application to indicate if the location is a sub-part. If your clinics all bill with one TIN and the $$ all goes to one address, under one group name, then you would bill with the Type II NPI number that is assigned to the central office location.
Also, box 24J contains the individual therapist NPI number who performed the service. Box 32A contains the NPI number for the facility where the services were rendered, 32B is the insurance company legacy number for the facility where the services were rendered (if there is one). Box 33A contains the NPI number of the central office (where you want payment to go), 32B is the insurance company legacy number for the central office (if there is one).
Wow, now I need a break!
Hope that helps,
Michele
Question
Hi Alice, I am new at sending out NY Workers Comp. claims and have a couple of questions. When sending the C-4’s to the insurance carrier does the doctor have to personally sign each of them? Can I just stamp his signature? Also is it necessary to send along the notes for the visits we are billing? Any help you can offer will be appreciated.
Susie S
Answer
Hi Susie,
It is not necessary for the Dr. to personally sign each form. You certainly can stamp his signature if you like. Our practice management system completes the C4 form and just prints out the doctor’s name. Others print out “signature on file” in that box. In either case it is considered a “computer generated signature” and is acceptable. As far as attaching notes, some workers comp carriers require them, but most don’t. If you are submitting any volume of claims, it wouldn’t be productive to attach notes to all. We only attach the notes on the claims that they are required for. If you are only submitting one or two, and the notes are available, it may help to speed up processing to attach them.
Hope that helps,
Michele
PS from Alice –
We do have one small workers comp company that requests a real signature. When we mail out our workers comp claims I make sure I sign each doctors name on that one company’s claims. This one particular company will not pay claims without a real signature. There’s always one exception.
Alice
Question
My doctor’s office collects copays up front, before the patient is seen. According to our contracts with various insurance companies, we are supposed to collect a copay from the patient at the time of the visit. When the insurance company processes the claim, they do not apply a copay amount, (they pay the contracted amount in full), or they apply a different dollar amount for the copay. What do I do?
Deb K
Answer
How about lunch?
Just kidding. Copays are suppose to be collected at the time of service. It’s possible the specific services being performed don’t require copays. If the EOB shows that no copay is due I would refund the copay back to the patient, or credit it to the next visit. Insurance companies just keep finding more ways to make our jobs difficult!
Good luck,
Michele
Question
Hello,
I would like to find the CPT codes/fee schedule for FL PIP 2008. I read somewhere that some codes changed, but I have not found any changes.
Thank you in advance,
Bianca
Answer
Hi Bianca,
I did a little research on your question and I found the following blog entry from a FL law firm which seems to outline the law: http://www.jameshartlaw.com/blog/index.cfm?id=1156 It looks like the fee schedule is 200% of the Medicare allowed amount for each CPT code. You can get the Medicare fee schedule amounts from the Medicare website: http://www.floridamedicare.com/
hope that helps.
Michele
She responded
Thank you so much Michelle. I knew about the 200% but what no one seems to be telling us is what are the covered and non-covered codes for this new PIP changes. For instance, 97014 is now G0283 for Mcr & UHC, but is it for PIP too? 97010 is a non-covered service for MCR nor anyone for that matter, but does that apply to PIP too? They used to pay for that code, now what? I suppose I was trying to ask a vague question in hopes that there would be one site that would answer all my questions. OH CHANGES……sometimes they’re really not worth it, huh?
Thanks again Michelle,
Bianca
Michele’s Answer
Bianca,
Unfortunately there is not a site that just answers the billing questions for PIP. I would recommend billing all codes for services performed, whether you think they may or may not be a covered service (97010). Better to get a denial, then not get paid. As far as the 97014, I would bill it as the 97014 which is what the AMA uses, even though Medicare & UHC use the G code. The PIP’s in NY go by the 97014. If it comes back denied, you can always resub as the G code and switch it over then. If there isn’t a Medicare allowed amount (97010), just bill your regular fees.
Thanks,
Michele
Great answer! Thank you. I will do just that. again….ahhhhhhhh why all the changes? LOL
Have a wonderful day Michelle, thanks a million,
Bianca
Question
Hi Alice ~ Good day!
I just want to know if you have an idea what the best billing software is that should we use and why?
Thank you very much…
In every good wish I remain,
Yanelle.
Answer
Hi Yanelle,
We’ve been working on a software comparison page, but unfortunately we haven’t been able to allow as much time to it as we would like. First of all, what do you need the software for? Are you a one doctor practice, a medical group, or a billing service? Are you already established or just getting started? If you are a small practice, Medisoft has a reasonably priced software that is good. There is also a free software that I’ve had a few people tell me they really like. I can’t remember the name right now. If you are a billing service, you’ll probably need a better software. Another consideration is how many computers will be used. You might want to read our page on software at http://www.solutions-medical-billing.com/medicalofficebillingsoftware.html.
Hope this helps some,
Alice
Yanelle answered
Hi Alice,
Thanks for the prompt reply and i appreciated it so much..=) Actually were just getting started on a medical billing service. We trying our best to research some beneficial information in order for us to become knowledgeable in the field of medical billing though our staff has 5 years hands on experience in medical billing and coding. We are trying to familiarize right now the NDCMedisoft version 11 and we are very happy that NDC medisoft is a good software.
Thank you very much and God Bless!!
Just keep`n touch,
Yanelle
Question
Hello Alice!
You have helped me previously on 2 questions, and I have now run into a problem I can’t seem to resolve. Our doctor was a solo incorporated practice with both an individual NPI and a corporation NPI number. He only had an individual Legacy PIN (None for the Corporation). I say was because he died suddenly on October 29th. We are using a Locum Tenens to cover him as an employee of the Corporation. I know that usually the Locum Tenens number goes in 24J and must match Box 31 on the HCFA form and that usually the Corporation Name and Address go in Box 33 with the Corporation NPI number in Box 33a. I have also entered on the HCFA 1500 claim form, that the Locum Tenens is covering our deceased doctor until he can be replaced (I show his name and individual NPI number) in box 19. My problem comes in when I bill Medicare. According to the NPPES our Doctor is a Entity Type 1 and the Corporation is an Entity Type 2. Do I bill as Entity Type 1 using the deceased doctor’s name and NPI # or because the checks need to go to the Corporation, do I bill as Entity Type 2 using the Corporation Name and Number in Box 33 and 33a. If I bill as Entity type 2 is it necessary to enter our deceased doctor’s NPI or Legacy number in any specific box. I’ve verified all the numbers and names on the NPPES database and still I’m getting rejections. HELP!
Many, many thanks for any assistance you can give in this very confusing matter,
Diane
Answer
Hi Diane,
I’m sorry to hear about the doctor. Anyway, you are in a bit of a mess. You cannot bill under the deceased dr’s name and individual legacy number for Medicare. The fact that he didn’t have a group Medicare number under the Corporation is a problem now. I would contact Medicare to make sure, but I think you are going to have to apply for a group Medicare number now, under the corporation, and then reassign the benefits of the locum to the corporation. You will have to hold billing until you obtain a group Medicare number.
Good luck with this,
Michele
Question
Hello Alice,
I wanted to know once you register your medical Billing Service, do you need to register with Medicare and other insurance carriers?
Thank you,
Jacqueline R
Answer
Hi Jacqueline,
No you don’t. Only the providers who are going to get reimbursed by the insurance companies need to credential with them. You don’t need an NPI number either.
Alice
Question
Is there any way to get an untimely non-pps claim paid?
Michael L
Answer
Hi Michael,
By non pps you mean non participating provider right? If a claim is denied for timely filing then you can appeal it with either proof that it had been previously submitted (like a patient ledger showing the dates previously submitted) or with a letter explaining why the claim was not submitted timely. Many times they will pay the claim. (But not always!)
Hope that helps!
Michele