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General Questions / Re: What Advice Do You Have?
« Last post by kristin on August 19, 2018, 08:36:17 PM »
Congratulations on furthering your education and career goals, I think medical billing/coding is one of the most interesting fields to be in, and presents lots of opportunities for the right person.

One thing you will need to decide is if you want to just code, and get your CPC, or if you would prefer to do medical billing, which does involve knowledge of coding, but you don't need a CPC. Or, if you want to do both, which is the case with some medical practices. For me, I much prefer billing over coding, but everyone is different. Once you get a clearer idea of what is involved with each, you can decide what works best for you.

Some things to consider:

1. Finding work as a coder with a CPC-A before the A gets dropped off is not easy. Even with the A dropped, most places want 3-5 years of experience. And finding remote work is really, really hard unless you have 5 years experience. There are some places that will hire CPC-A's or CPC's without that kind of experience for remote work, but they aren't the best to work for, and the pay is generally abysmal.

2. When starting your job search, start early, even while still in school, and apply for everything even remotely related to billing or coding. Medical records, receptionist, registration, back office assistant, etc. Or as they say on a lot of billing/coding forums: "just get your foot in the door".  A lot of people in this field start at a practice or hospital at an entry level job, and work their way up. For me, I started in 1996 rooming patients at a podiatry office and within three years I was the office manager and in charge of everything, including billing/coding. I still hold that job, plus doing remote billing/coding work for 6 other doctors of various specialties, all because I took an entry level job all those years ago.

3. Network, network, network...a lot of time it isn't how much you know, but WHO you know. I got my job at the podiatry office because my mom was a patient. I got my first remote billing job because I was on a billing/coding forum and answered every podiatry question that people asked, and someone who needed a podiatry biller contacted me. Join every online forum you can find, every Facebook page open to people to join, and if you want to pursue coding, attend AAPC chapter meetings in your area. Talk to your personal doctors and see if they need help, or know of an office that does.

4. Keep in mind that with the majority of providers using EMR, the need for coders has dropped. ICD-10 changed that for awhile, but that hiring upswing seems to be over. Most coders I talk to seem to get hired at hospitals, or in risk adjustment/DRG/auditing jobs. While there are still solo/group providers that hire coders, it isn't like it used to be. Some EMR companies also do billing, but because it isn't done the way it should be, there is still a need for billers, more so than coders, from what I see. While an EMR can code (and not always accurately), they can't call on claim denials, and do other things needed in the revenue management cycle.

5. Professionalism in this field is key, since hospitals and offices are professional places. (Or they should be). When I am looking to hire someone, the candidate had better be professional from the start. Things I look for are: professional resume with no grammar/spelling errors, professional sounding e-mail (such as janesmith@gmail.com, and not sparklegirl@gmail.com), speaking with correct grammar/syntax, and professional appearance. By appearance I mean no heavy makeup, no heavy perfume, dressed conservatively, no tattoos or face piercings, no obnoxious nails, etc. I have six tattoos, but you would never know it, and that is what I expect from potential hires. You have to stand out from everyone else, but not in the wrong way.

6. Above all else, NEVER give up hope finding a career path in this field, but also know that it is over-saturated and there are only so many jobs available. So many people have decided to try this as a career because they were told they could easily work from home (false), and there are a lot of jobs available (false). Be prepared to send out 50 resumes or more, and not get one call back. Be prepared to do something else for work while trying to get a job in this field. This is why it is so important to stand out from everyone else, so do whatever you can to be that person.

Best wishes to you as you continue your journey!
Kristin
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General Questions / What Advice Do You Have?
« Last post by Brianna.Ramirez on August 16, 2018, 04:13:43 PM »
Hello all! I am currently enrolled in classes for medical billing and coding. What advice do you have regarding this career field once I finish my schooling?
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Medical Billing Software Questions / Top 10 Medical Billing Software Vendors ?
« Last post by mdvision on August 16, 2018, 12:28:18 AM »
Many EMR and medical billing solutions are available in market but its difficult to select perfect one according to requirements How can we found the best medical billing software ?
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Insurance Payments / Re: Overpayment scenario
« Last post by kristin on August 15, 2018, 08:39:29 PM »
I don't deal with auto accident claims, so my knowledge is limited, but I would think that they would be the only insurance you could bill in this scenario, and it shouldn't have gone to BCBS at all. Someone will correct me if I am wrong.

That said, when you submitted claim to BCBS, did you include EOB from auto insurance payment? If not, that could be part of the issue.
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Insurance Payments / Overpayment scenario
« Last post by Hfitting18 on August 15, 2018, 10:07:56 AM »
I am very new to this position and am learning as I go. Not sure how to proceed here - a personal injury patient's auto insurance covered 80% of our claim. I submitted to BCBS for secondary, they covered 100% of the allowable amount resulting in a total payment of $256.26 on a $210 claim.

Here is a detailed breakdown of remits:
Charge $210
Auto paid $168
Patient CoPay due $42
Submitted to secondary
BCBS paid $88.26
Contractual Adjustment of $121.74

I think BCBS didn't take the prior payment information into consideration? Any direction is greatly appreciated :)
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Medical Billing Software Reviews / Re: Looking to change software
« Last post by mdvision on August 15, 2018, 08:50:28 AM »
mdvision  EMR is the top rated EHR and Medical Billing Software within your budget ONC Certified
https://mdvision.net/white-label-pm-emr.html
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Billing / Re: Billing under supervisor for Blue Cross Blue Sheild
« Last post by s0b3k111 on August 15, 2018, 02:41:29 AM »

I'm not sure what you mean by this.  Don't you bill all services at the same fee and then let the insurance carrier process at the appropriate rate?

Well, previously (and probably incorrectly like I said), all of our LMSW/LPC/LLP billing was done directly under the LP's NPI number (only for BCBS). So we received the rate for an LP. So we did bill at the same fee, but we didn't include modifiers to indicate that there was a lower licence level because our (mis)understanding was that we were able to bill under the supervisors lisence.


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Are you in Michigan?  Are you referring to the BCBS PGIP?  If so, you would have to check with BCBS to find out if you can avoid it.

Yes we are in Michigan, and since we do not participate in any physician organizations, so is there a way to not be forced to pay this fee?


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Most medical offices set a fee schedule for their services.  All services should be billed at that fee schedule and then adjusted according to the EOB/ERA.  It is common for offices to set a fee schedule anywhere from 125-160% of Medicare allowed amounts for their area, even if they do not enroll with Medicare.  It's a good gauge to use when setting fees.  For example, if Medicare allows $67.56 for a 90834 the a common fee might be $95.    I hope this is helpful!

So for us we bill at different rates depending on the insurance (again not sure if that is wrong or not). Aetna at 125, BCBSM at 145, Medicare at 105 etc. Each company has a slightly different cost. I hope that explains it more clearly, and yes you were helpful.

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Billing / Re: Billing under supervisor for Blue Cross Blue Sheild
« Last post by Michele on August 14, 2018, 01:14:29 PM »
I am wondering a few things:
Is there a way to bill at the LP's rate legally

I'm not sure what you mean by this.  Don't you bill all services at the same fee and then let the insurance carrier process at the appropriate rate?

Is there a way to avoid PGIP, we are not a part of any physician group, and have not been previously charged this.

Are you in Michigan?  Are you referring to the BCBS PGIP?  If so, you would have to check with BCBS to find out if you can avoid it.

If the BCBS max allowable for our practice is $160 for LP should we bill $160 or slightly under?
Why is this information so hard to find?

Most medical offices set a fee schedule for their services.  All services should be billed at that fee schedule and then adjusted according to the EOB/ERA.  It is common for offices to set a fee schedule anywhere from 125-160% of Medicare allowed amounts for their area, even if they do not enroll with Medicare.  It's a good gauge to use when setting fees.  For example, if Medicare allows $67.56 for a 90834 the a common fee might be $95.    I hope this is helpful!

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Billing / Billing under supervisor for Blue Cross Blue Sheild
« Last post by s0b3k111 on August 14, 2018, 06:42:00 AM »
Preface: I am not a medical biller, we have recently let go of our biller and I believe that she was not doing her job correctly.

I help manage a psychological clinic (7 LP, 3 LLP, 5 LMSW, 5 LPC is the licensure breakdown), and previously we billed all of our blue cross claims under our LP's only. They provide direct supervision for all of the clinicians that we submit claims under them for. Our most common CPT code is 90837 as a standard appointment is 60 min for us.

I am wondering a few things:
Is there a way to bill at the LP's rate legally
Is there a way to avoid PGIP, we are not a part of any physician group, and have not been previously charged this.
If the BCBS max allowable for our practice is $160 for LP should we bill $160 or slightly under?
Why is this information so hard to find?
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Starting Your Own Medical Billing Business / Re: Vacation and Time Off
« Last post by LoveBilling on August 13, 2018, 01:29:31 PM »
Thank you Michele. That's what I was thinking as well, make myself available by having phone and laptop to connect to what I need. Was curious how others handle these situations since it seems like there are a lot of solo billing company owners out there. Question came up to me as I begin writing my compliance and P&P.

I do have someone that will be available to help when I get started, I'll keep in mind and train eventually to cover for me when it gets to that point.

Thanks,
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