Medical Billing Forum
General Category => General Questions => : PTBILLER September 30, 2009, 11:56:26 AM
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Hello!
Does anyone bill for any providers in Florida? Per phone call this morning, I did find out the BCBS of FL is not accepting any contracts for PT/OT's. Therefore, this provider will be billing OON. They do have a provider registration form. Any input on BCBS of FL??? (as far as enrolling as a provider)
Also with First Coast as their Medicare Intermediary....this provider has heard horror stories...any input on this???
Thanks for any input you guys could help me out on.
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OOPS..wanted to add...do you have to go through Availity to bill electronically??
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BCBS will not honor assignment of benefits for non par providers so you want to discuss this with the practice and if feasible get patients to pay at the time of service or devise a form which requires them to remit the check to the practice, just be prepared because if you bill high dollar claims and BCBS pays the patient, it's damn hard to collect that check from them. Several states have gone to court over this and it has been deemed as legal for the insurance carrier to NOT honor assignment for non par providers as long as it's disclosed in the policy (which it is.. already looked at those loopholes)
As far as filling electronic, I'm not sure you would have to check with them or your clearinghouse, In NJ, NY and CT I'm able to file using various clearinghouses if I choose.
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BCBS will not honor assignment of benefits for non par providers so you want to discuss this with the practice and if feasible get patients to pay at the time of service or devise a form which requires them to remit the check to the practice, just be prepared because if you bill high dollar claims and BCBS pays the patient, it's damn hard to collect that check from them.
speaking as a biller of a non par high end custom rehab provider.............she speaketh the truth. I have had to track down check of 28,000+ from clients. This is the hardest part of my job is tracking the payment, keeping up when the check has been cut in case it goes directly to the client.
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I advise my clients that if they cannot or will not par with BCBS they need to collect up front. If BCBS or any network says they are closed, all is not lost, with a letter of intent and a service you can show is prudent to your geographical location you can get into a closed panel. For example, I had a group of psychologists who were told their BCBS network was closed, they all provided two services that were not available but by one other provider within a 30 mile radius (Biofeedback and EMDR) we wrote the carrier a letter of intent (LOI) explaining this circumstance, they sent us a letter they would review and about 3 weeks later we were sent a packet and completed the credentialing process. If the provider cannot par or doesn't want to then I educate them on the importance of collecting the full charges at registration.. so far this works, we sent out letters to all BCBS patients explaining this and they are to pay their fees at the time of visit and then free to cash the checks when BCBS reimburses them. With high dollar surgical or DME fees it is harder but you can work with the practice's attorney to come up with some sort of financial contract with each BCBS patient. I spoke with an OBGYN the other day who has opted to NON par with BCBS and she has payment plans setup for her OB patients.
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Yeah thats great, just hard for us to do on high-end DME
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Florida BC tells all specialties that they are not accepting any more as far as I can tell. If you have anything that makes you different from any other PT, such as a specialty like post stroke victim using dog therapy (obviously an example), you can appeal stating you are unique but it's still not a guarantee.
First Coast Service Options are one of the most difficult Medicare Carriers I have ever dealt with. For credentialing anyway, not for claim payment.
Availity is just one of many clearinghouses. Like Linda said, you need to see what your software is compatible with.
Michele
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Hey Linda, since you are the previous insurance worker...what would be a reason a carrier would close its network?? I would think they want more providers in network with them.
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I've always wondered the benefits of closing the network as well. I can see the benefit to the providers that are in the network, but not for the insurance carrier, except that they have less providers to maintain. I had BC of NC tell me that they close the network "to protect the providers they have" but again, that doesn't really make a lot of sense to me.
Michele
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They have an internal CAP on network providers by network and then by geographic location. It has something to do with Risk Analysis..the more providers they have the more they pay out.. lol that's it simply :o
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ughhhhhhhh