Author Topic: NY based billing company billing for NJ Provider?  (Read 11573 times)

galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #15 on: January 24, 2013, 03:05:57 PM »
Richard, I understand what you are saying.... some billers do that and some don't. I have a doctor in New York who I tried to give him that advice and he kindly asked me to never tell him any advice and how to do things, he's set on his old way and he wants to do things the way he is used to saying so in this case, it is a data entry account, where he only wants me to bill whatever he writes on the super bill. So you cannot say its never what we are given that we bill. Every doctor is different, every practice is different. Having said all of that its the doctors responsibility to check on a daily basis what the billing company is doing! Bottom line. I've seen this with my own eyes, a doctor was suing a billing company, trying to say that because of the billing company he was audited from different insurance company and had to over pay thousands of $ due to billing company error. You know what the judge told him? Where were you when the billing company was billing this? Did you not check your biller? Did you not check reports?  Oh you didn't have time to check? That's your problem.
Bottom line, doctors need to check billers!!!!!

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #16 on: January 24, 2013, 03:08:44 PM »
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With all due respect, I've been in this business probably a bit longer than most people here. Not only have I've been in this business longer, I have an MPH in healthcare administration as well so as far as laws are concerned, I think I know them better than anyone on this forum. Having said that and clarifying that, I am not saying that a biller's job is simply data entry however, at the end of the day, its the doctor who is responsible for their billing! It's the doctor that has to know what is going on in their practice! At the end of the day, its the doctors responsibility to CHECK what the biller is billing, what codes she or he is using, what is collected, etc. The point I was trying to make here is that its still the doctors responsibility to know what is going on in their practice. Yes if you are given a code you should know what that code means however its the doctors responsibility to know the codes, not the billers! As much as you don't want to think of yourself as only a data entry person, you are DOING DATA entry. You are entering the information the DOCTOR gave you to bill. Maybe  you don't want to look at it this way but hey we all doing data entry. To collect, is a different story, yes I agree,  it's much more complicated that than, but as far as entering the information from a super bill is called DATA ENTRY. I don't agree with you on a lot of things you say on this forum and the advice you give to people that are just starting, but everyone is entitled to their own opinion. This is just mine.

Well then.. hey, I have a great memory. YOU have been the one to mislead as in the following thread
http://www.medicalbillinglive.com/members/index.php?topic=6985.msg20613#msg20613    YOU state in Nov of 2012 this is your first account.  Now not to split hairs but having been in this industry and having had your own billing company for many years can be different. I'm a good example.   I spent 11 of my 24 years on the OTHER side. ...   

And what you stated above isn't OPINION..  what I stated .. IS NOT opinion.    It is a FACT:  IF YOU HIT SEND on that claim. YOU ARE JUST as libel as the provider and the coder who coded the claim! 

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I don't agree with you on a lot of things you say on this forum and the advice you give to people that are just starting,

Yes, I'm aware that many people don't appreciate the bold, brash opinions I have, but my intentions are only to save people some time. I'm not here to SELL anything.. So I have nothing to lose by being honest and up front and I resent being told you know more than me. THAT is an opinion and one I'm going to disagree with.   
Linda Walker
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PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #17 on: January 24, 2013, 03:16:06 PM »
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Richard, I understand what you are saying.... some billers do that and some don't. I have a doctor in New York who I tried to give him that advice and he kindly asked me to never tell him any advice and how to do things, he's set on his old way and he wants to do things the way he is used to saying so in this case, it is a data entry account, where he only wants me to bill whatever he writes on the super bill. So you cannot say its never what we are given that we bill. Every doctor is different, every practice is different.

HOLY cow read this back to yourself again .. Are you serious?    If you know so much about this business, I'd love to see your compliance plan.  JUST because you are given something to bill does NOT mean you blindly shut your mouth, turn off your brain and leave your responsibilities. Your completely WRONG. You need to go do some serious research on legal precedences where actual billers have paid their OWN penalties and fines and even Jail time for just keeping their mouth shut and doing what their told.   I am smart enough to kick that type of client right to the curb. Who is the expert here? HE went to medical school.. You supposedly know the laws regarding this industry? If that's an example of what you know, you are disillusioned.  Who the heck taught you to keep your mouth shut and do what the doctor tells you?  Any doctor that tells you to shut up and do what they say is basically telling you to suck it up and take the risk. I really hope you have good insurance and even if you do, remember that in the eyes of the law regarding fraud and abuse "IGNORANCE is not an excuse".  You bill the charges, YOU are responsible for knowing what your billing .. PERIOD.

 
Linda Walker
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galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #18 on: January 24, 2013, 03:23:06 PM »
Read this back to me? Excuse me? I don't need to read anything back to myself because like I said, I know what I know and you can tell me whatever you want but what you are saying is completely FALSE and pretty much everything you say here is false and people are just taking your advise thinking you know something about this business. My compliance plan states everything it needs to state if not more than yours. You come off thinking you are better than other billing companies ranting about how you tell doctors about compliance plans and they never even heard of it, trying to come off like you know more than other billing companies. You don't, after what I read that you have to say that billers are responsible for doctors billing. The fact that you think that doctors are not supposed to know billing is a problem in itself. DO You even know that doctors by law must learn coding and billing! Do you even understand what you are saying. Yes, doctors in medical school and in residency learn about billing and coding. HELLO!!!!!!!! You should do some research instead of telling me to do research before giving advice to people. I did my research and I do know that its the doctor who is responsible for billing codes, not the billers.

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #19 on: January 24, 2013, 03:33:36 PM »
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Read this back to me? Excuse me? I don't need to read anything back to myself because like I said, I know what I know and you can tell me whatever you want but what you are saying is completely FALSE and pretty much everything you say here is false and people are just taking your advise thinking you know something about this business. My compliance plan states everything it needs to state if not more than yours. You come off thinking you are better than other billing companies ranting about how you tell doctors about compliance plans and they never even heard of it, trying to come off like you know more than other billing companies. You don't, after what I read that you have to say that billers are responsible for doctors billing. The fact that you think that doctors are not supposed to know billing is a problem in itself. DO You even know that doctors by law must learn coding and billing! Do you even understand what you are saying. Yes, doctors in medical school and in residency learn about billing and coding. HELLO!!!!!!!! You should do some research instead of telling me to do research before giving advice to people. I did my research and I do know that its the doctor who is responsible for billing codes, not the billers.

And no response regarding your post previously that your account in NOVEMBER of 2012 was your first??    YOU SAID:
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Hello Everyone! I just got a new account and it's my very first one. I wanted to know what report I should run to bill for my services? Do you guys run a monthly posting report? How do you make sure he's giving you all the eob's? Can someone help me with this process.
whats the best report to run at the end of the month?
Thanks

I did not say physicians should not understand billing.. however they do NOT teach coding or administrative things in medical school.   Why do you think WE do this job?  You can certainly run your business as the little employee who will claim to do whatever the provider tells her to do. That's fine. I do URGE you to get a professional opinion from your own attorney if you have one.  If he tells you what you just said.. then I feel double sorry for you.     I did not say I was better than anyone else. But I've stated over and over, I have NOTHING to gain by misleading people into thinking this is just a data entry job, as you seem to infer it is.  I run my business. I don't rely on my clients to educate me, I educate them. They pay me to give me my experience, if they do not want to play by the rules, I don't want them as a client.  If I wanted to be "free of any responsibility and be a data entry clerk, I would go get a job and do data entry".       It is you that IS indeed wrong.    I'm not wrong at all. IF YOU PUSH send on those claims.. YOU assume JUST as much liability as your provider.   PERIOD.
« Last Edit: January 24, 2013, 03:36:07 PM by PMRNC »
Linda Walker
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galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #20 on: January 24, 2013, 03:36:49 PM »
Ok, STOP RIGHT THERE BECAUSE YOU DONT KNOW WHAT YOU ARE SAYING IF YOU ARE TELLING PEOPLE THAT DOCTORS ARE NOT taught in MEDICAL SCHOOLS ABOUT CODING. Do you just make up things? My husband is a physician and I know for 1000% that doctors are taught codes, billing, cpt codes etc. My husband took a course on billing because it was mandatory for him to learn this in MEDICAL SCHOOL! NOT ONLY IN MEDICAL SCHOOL, THEY HAD BILLING COMPANIES COME OUT TO THEM IN RESIDENCY TO TEACH THEM THESE THINGS!

galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #21 on: January 24, 2013, 03:41:44 PM »
you are doing their billing because doctors don't have time nor desire to do this. Doctors are treating patients, not doing billing. However I know few doctors that do their own billing. For your information, not only did I ask this question from an attorney, I actually contacted department of professional misconduct services with the same question, and you know what was their answer?? its the doctor who is responsible for his billing, NOT THE Biller! so I seriously feel bad for you, you shouldn't feel sorry for me because I have the correct information, I contacted the right people. Where did you get your information? No where, you are just talking, ranting, ranting information you don't know. I told you previously, I knew someone who tried to sue their billing company and it was the judge who told the doctor that It was him responsible for his billing not the billing company. You wan't to continue thinking whatever you are thinking, go ahead, I am not trying to change your mind but you are wrong. Done.

galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #22 on: January 24, 2013, 03:43:06 PM »
and I did reply to you about the post I made back in November. Maybe you have a good memory but you must have a vision problem.

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #23 on: January 24, 2013, 03:49:14 PM »
Oh great.. so tell me again why your needed?  Maybe in all my 24 years of doing this all the doctors have been LYING to me.. hell .. they don't need us, it's taught in medical school.   Again... Not going to address your NOV of 2012 post where you state you got your First account?    Ok.   My first account was while I was working full time for an insurance company.   Did I mention I worked in the fraud dept?  Yes I did. in 2 of the 3 companies (both in top 5) I did indeed oversee cases in which both biller and doctor were named.   My attorney also has represented many billing companies, some brought up on charges independently of the provider. 

Whatever..you do what you are doing.. I will do what I do which is accept responsibility for the credentials of my experience.
Linda Walker
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PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #24 on: January 24, 2013, 03:59:04 PM »

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and I did reply to you about the post I made back in November. Maybe you have a good memory but you must have a vision problem.

I'm sorry, I guess my vision is lacking.. not seeing it.

I have a great compromise.   You continue to be the "good little employee" who does what the doctor says. And I'll run my business with professional ethics and utilizing the experience I have. How's that sound?       I'm just curious though.. if what you say is true.. What does your Liability insurance clause say regarding responsibility? I'd be happy to retype mine for you.  I also specialize in Healthcare administrative law. YOUR contract with your employee's can say whatever it wants.  A simple ONE call to Medicare would tell you otherwise if you think JUST because your told to bill something, your not responsible.   I'm sorry but you are absolutely in the minority in your thinking.   
Linda Walker
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PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #25 on: January 24, 2013, 04:03:09 PM »
Since you seem to KNOW more.. Your words, and YOUR compliance plan is better, and YOU have more experience.. ask again how you got confused with this original post regarding states and professional 3rd party registrations vs. S corps?   You use the word "confused" a lot.. as in your previous posts. So I just wonder why you bother to ask or state your confusion when you seem to know it all.?
Linda Walker
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QueenAlicia

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Re: NY based billing company billing for NJ Provider?
« Reply #26 on: January 24, 2013, 04:08:09 PM »
Wow, well. I guess when in doubt consult with an attorney.  Seek one that has experience with the medical field.  Good luck and after this I need to call to increase my E&O, yikes lol.

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #27 on: January 24, 2013, 04:13:28 PM »
I like to second guess myself.. it's what keeps me fresh.. sharp and alert.   so I posed your question to our facebook group and if you are on facebook I would welcome you to view the comments so far:   http://www.facebook.com/groups/PMRNC/#!/billerswebsite    I guess it's only fair you get more than just my opinion.

OH.. ONE more thing..   In previous posts in this forum you have said you charge a % of collections.  You also stated you are in the Florida area.   And then .. news flash your husband is a doctor (I assume in Florida also)   Do you know that fee splitting in the state of Florida is illegal?  You even moved from a state that prohibits fee splitting to another that does: 

 http://www.medicalbillinglive.com/members/index.php?topic=6950.msg20559#msg20559

Florida Statute:

 The basis for the final order appears in F.S. 458.331(1), which sets forth a list of acts or omissions for which the board may take disciplinary action against a physician's license. The list includes 458.331(1)(i), which prohibits "paying or receiving any commission,
bonus, kickback, or rebate, or engaging in any split-fee arrangement in any form whatsoever with a physician, organization, agency, or person, either directly or indirectly, for patients referred to providers of health care goods and services . . ."This is an article From the Florida State Bar in regards to Illegal fee splitting and cites a perfect example. 


I have case precedences on this.. but I've given you enough free information to go look up.


And another of your previous posts:

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I am not a coder however if I can get advice on something and get paid for it why not? You don't need to be a certified coder nowadays. Everything is available on line! I already got the information and billed it out!



How much more about the law do you know??
« Last Edit: January 24, 2013, 04:44:56 PM by PMRNC »
Linda Walker
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PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #28 on: January 24, 2013, 04:18:55 PM »
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Good luck and after this I need to call to increase my E&O, yikes lol.

Alicia.. I know.. I almost went to pull my policy too!
Linda Walker
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Christy

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Re: NY based billing company billing for NJ Provider?
« Reply #29 on: January 24, 2013, 04:42:47 PM »
For those of you verifying the dr's codes: how do you know if the doc is performing the service or not if you are off site? I get what galina is saying as far as the dr being responsible to report what he or she is doing....

do you all see the actual medical notes? for me, the doc faxes me a log sheet with dos, cpt and dx codes...unless the codes are bundled or not appropriate for the specialty or s/he asks for my advice, how would you know if the codes were fradulent?

BTW- I am going to add a statement to my billing log where the doc attests and signs that the codes he is providing are accurate and that he performed the services.....