Author Topic: Medicare Billing  (Read 365 times)

TurningPoint

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Medicare Billing
« on: August 02, 2017, 12:03:25 AM »
Our agency just became In Network with Medicare.  I have been looking for a free portal to submit Medicare claims.  We are currently using the following portals to submit claims Optum for UHC, Emdeon for AmeriHealth, Availity for Amerigroup, PC Ace for straight Medicaid and then Blue Cross Blue Shield has their own.

Each of these portals are free to submit claims.  I am looking for the same for Medicare.  I have spoken with each of these and to include Medicare, we would have to increase to Premium Memberships.

We are a small agency with one Mental Health Counselor and one Substance Abuse Counselor and 3 clients that have Medicare.

Are there any free portals out there to submit claims?

Thank you.

Michele

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Re: Medicare Billing
« Reply #1 on: August 02, 2017, 08:51:47 PM »
I believe you use PC-ACE Pro 32 to submit Medicare claims.  It has been many years since I have used it but that is how it used to be done.
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Shawn

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Re: Medicare Billing
« Reply #2 on: August 03, 2017, 12:47:05 AM »
Have you looked at Office Ally? They process claims for hundreds of commercial insurances as well as Medicare (not sure about Medicaid.) I find it so convenient, not to have to log in to multiple websites, although I do use Optum for UBH and United Healthcare just because it's such a user-friendly website. If your government claims are under a certain percentage of your overall claim submissions in any given month, Office Ally is free.

Also re: Office Ally, I've had two client/providers who only needed to bill Medicare. The rest of their practice is cash pay (psych.) Each provider saw between 9 and 12 Medicare pts. monthly. If you can keep to 10 or fewer government (Medicare/Medicaid, etc.) patient billings per month, they waive their monthly fee (usually $19.95, I think.)

These two clients were very cooperative and if they saw more than 10 clients in a month, they were fine with me just carrying over the charges to the next month. So for example, they had a pt. they saw once or twice in a month, I'd hold off and bill those dates with the following month. There's no limit on the number of days per claim.

I am not affiliated with Office Ally, I just like using their website. (I don't bother with their Practice Mate.)
« Last Edit: August 03, 2017, 12:48:37 AM by Shawn »

Michele

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Re: Medicare Billing
« Reply #3 on: August 03, 2017, 09:50:47 AM »
Wow, I love Office Ally and have used them for years.  Not a fan of Practice Mate.  But I didn't realize you could enter claims right into OA?
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TurningPoint

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Re: Medicare Billing
« Reply #4 on: August 03, 2017, 06:57:29 PM »
Thank you for the information so far.  I am looking into Office Ally currently.

There is a part however that states:

  • If my Government/Non-Par (G/NP) claim volume is greater than or equal to 50% of my total claim volume in a month, my account is subject to a processing fee of $19.95 for that month*.
  • If my Government/Non-Par (G/NP) claim volume is less than 50% in a month, I will not be charged this fee for that month.

My plan would be to use Office Ally to submit Medicare.  Right now we only have 4 clients that maybe come 1 time per week.  So 100% of my claim volume would be G/NP.

Am I right in my conclusion?

Michele

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Re: Medicare Billing
« Reply #5 on: August 04, 2017, 11:50:36 AM »
If you use OA for only Medicare then yes, you would have the $19.95 a month fee, and if you are only submitting a few claims a month that wouldn't be feasible.  Did you look at the PC-ACE Pro software that is free from Medicare?

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TurningPoint

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Re: Medicare Billing
« Reply #6 on: August 04, 2017, 12:06:56 PM »
Michele,

We use/used PC Ace to process our few Medicaid claims (No MCO) and we have had so many "detail" problems getting claims processed that I was using it as a last resort.

I spoke with a Customer Service rep with Office Ally and she stated that if we submit 10 or less claims per month regardless if they are G/NP or not that we will not be charged the $19.95 fee.

I am hoping this representative is correct.

Michele

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Re: Medicare Billing
« Reply #7 on: August 04, 2017, 08:04:07 PM »
Actually I believe that may be correct.  I haven't personally experienced that but I heard someone else say that as well.
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Shawn

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Re: Medicare Billing
« Reply #8 on: August 12, 2017, 03:46:43 PM »
Michele, and "Turning Point", yes that rep is correct. I have a client who has typically been seeing 10 or fewer Medicare pts. per month since I started doing her billing in 2014. The rest of her practice is cash-pay, so 100% of her claims submitted through O.A. are Medicare. There is no monthly fee in this case. For the occasional month when she saw more than 10 MC pts., I just carried over those DOS to the following month, since the number of DOS per claim doesn't matter.

However, you do have to be careful about resubmitting a "Fixed" claim within the same calendar month, as that counts toward the allowed 10 "freebees." Also if you're submitting to Medicare as the secondary payer, same deal.

It has happened to me just a few times when I wasn't keeping careful track. Just the cost of doing business, it is a tax write-off after all.  ;)

Michele

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Re: Medicare Billing
« Reply #9 on: August 12, 2017, 09:27:56 PM »
Good to know!  Thanks for sharing.  :)
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