Thanks Michele for your help. Appreciate it. We have the EDI side covered. I always thought the same thing - that Medicare payments always must be made directly to the provider, but I've recently read language from CMS' Integrity Manual, section 15.5.8, that a billing agency can accept payment. They state that "In order to receive payment directly from Medicare on behalf of a provider or supplier, a billing agency must meet the conditions described in section 1842(b)(6)(D) of the Social Security Act." The conditions in that section are a little confusing so I wondered if some other billing company out there has already vetted this. It sounds like I would need some kind of agency agreement. Am I reading this all wrong?
You are speaking of Medicare specifically. Medicare no longer sends paper checks (at least that's what they say). I'm not sure if some areas are still sending them but I don't believe they will.
Existing regulations at 42 CFR 424.510(e)(1)(2) require that at the time of enrollment, enrollment change request or revalidation, providers and suppliers that expect to receive payment from Medicare for services provided must also agree to receive Medicare payments through electronic funds transfer (EFT). Section 1104 of the Affordable Care Act (ACA) further expands Section 1862 (a) of the Social Security Act by mandating federal payments to providers and suppliers only by electronic means.
Linda, I read your link, which I found to be very helpful. One thing that I picked up on is that if I wanted to be the agency receiving the funds, I could not charge the provider a percentage of collections. Does the rule where I can't, as the billing agency, charge a percentage of collections apply if the money goes to the provider? It's a little confusing to me as to how I can charge my clients for billing Medicare.