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Coding / Re: OT 97165 and 96111
« Last post by June Lawrenz on February 22, 2018, 06:45:46 PM »
I'm not a coder either, certified or otherwise. Logically, that's how you stated it is what we thought it should be as well, because 96111 reads as  "extended testing". It made sense that the 97165 Evaluation would be first. However, the CCI tables showed 96111 in Column 1, with 97165-59 in column two. I did place the 59 on both lines. I'm hoping to file an Appeal, but not sure how that will play out. Thank you for your input.
My best advice is to hire a professional coder.. no matter for the first claim or the next 20,000 claims. Get a professional coders. Billing companies are not always coders, coders IMHO should be IN HOUSE and be available to review documentation.
Facility Billing / Residential mental health facility room and board claim in Nctracks
« Last post by Transnet on February 22, 2018, 04:45:45 PM »
I am brand new to filing claims and I am having problems submitting my first claim. As the director/owner of the Mental Health residential treatment facility I am responsible for submitting all claims. It would seem the billing company I hired does not supply the claim codes. Nctracks also does not supply the revenue or procedure codes I need to enter my first claim. Somewhere I was told the sign of intelligence is that when you need help ask for it. Ignorance is making the same mistake and expecting a different result. Today, I need help .Does anyone have experience with filing a residential mental health claim for room and board. For that matter I need to file the initial new patient visit cpt code 99328 with a not known revenue code. I have used HCPCS code T2048 with revenue code 120 semi pvt room and board with negative results as well as  revenue code 1005 B&H  R&B also with denial for wrong procedure code. Any help would be greatly appreciated.

Thank you,
Starting Your Own Medical Billing Business / Re: Unexpectedly got my first client today
« Last post by PMRNC on February 22, 2018, 03:28:47 PM »
I would add that it might make your job easier if you could obtain permission to work in their office for awhile, where you have access to all their records, until such a time as you have the data entry finished, and you've been able to gather the information you need to do your job in an organized manner.

EXCELLENT suggestion, I have actually done this to a point for all my clients since I changed business models a few years ago. I used to use my own software but over the years with companies going out of business, or the software being inadequate I decided I didn't want to be a slave to the practice management software vendor anymore. With that in mind the client didn't have to suffer the losses of time in reimbursement and there was NO messy conversion on my part either. What i did was spend 2 weeks in their office to get a feel for how their process was. I reviewed all policies, procedures, software, reports, etc..and then would get them setup in-house so that when I took over from my home office it would be smooth and easy.

Great Suggestion William!!
I wanted to start my own medical billing business yeaaaars ago.  I bought the books from this site and everything.  After a few more years experience and frustration from working underneath people, I decided to advertise my services as an independent contractor.  I figured I would get my company name out there and network through part time freelance work. 

Long story short, I sent my resume and cover letter to someone looking for a part time biller.  I went in for an interview with him today.  I really didn't know the details of what he wanted me to do, but it just sounded like part time billing from home and going in the office a couple days a week.  Ends up he was impressed by my experience enough that he felt I could possibly do the entire revenue cycle.  Actually, after seeing how mixed up he was, I kind of suggested it.  Plus, the little voice in my head was yelling at me to take this on. 

But I am not prepared for this, not really.  I've done my time in medical billing and wanted to concentrate on consulting.  But here's the situation at hand:  He has 8 doctors (soon to be 10).  His docs are designated physicians for workers comp cases, therefore he is legally owed the money for his services.  His problem is that he doesn't have time to collect and see what's going on. 

He didn't know what a PM system was, EMR, or anything.  He couldn't exactly tell me how much his practice makes monthly (he kind of just threw out $50,000 at me).  He didn't really know what a clearinghouse was.  He has a clearinghouse now but it's RIDICULOUSLY INEFFICIENT.  With all this information, it was difficult to hide my shock.  But he wants to hire me on as a contractor.  I told him I would accept 10% of collections, claim submission and tracking would be a different fee, as will be monthly reporting.  I have a feeling I will be downloading Office Ally in place of whatever he has now.  He just needs someone with some sort of "know how" around insurance.

It all sounds like a slam dunk, but omg....

Are there any suggestions on how to price monthly reporting and calculating consult fees?  Monthly reporting is more accounting work than showing my work for the past month.  The fact that he really doesn't know how much he was bringing in monthly and that he doesn't know how to use excel is insane to me... and I can't work with that.  We'll see how that all pans out but I would appreciate any advice or similar experiences.  I have a habit of biting off more than I can chew, and I have a feeling that's what I may be getting myself into.   

Being that I wasn't prepared for something like this, I am a little gun shy of spending a ton of cash.  But if I wanted to take the data from their system (which seems like some makeshift customized program in outlook) how would I transfer that to a software like totalmd?  How does the transfer from PM systems usually happen?  I don't want to do this too quickly because I don't want to scare them off with a ton of new changes when I'm not even in the door yet  :-\

PMRNC gave some good advise on fees. This sounds like a really messy but potentially lucrative opportunity for you. I would add that it might make your job easier if you could obtain permission to work in their office for awhile, where you have access to all their records, until such a time as you have the data entry finished, and you've been able to gather the information you need to do your job in an organized manner. From your description of their situation, I'm wondering how this could have happened in the first place, working with the front office staff to keep things organized and efficient is something that may be your next big challenge. You might wish to address this in your service agreement before you and the provider agree to move forward. Someone with your experience knows that working with front office staff that simply doesn't care or insists in working in a disorganized manner will make your job impossible no matter how good you are as a biller. 
Starting Your Own Medical Billing Business / Re: Started the process
« Last post by williamportor on February 22, 2018, 12:17:16 PM »
A few helpful things for your contract: Clauses stating you don't negotiate fees between the provider and insurance payers, the exact date each month when their fee to you is due and penalties for late payments, your right to adjust your fee at regular intervals, any legal disputes between you and the provider to be settled in your state and county. Important: Once you've written your contract, have it reviewed by an attorney before you or anyone signs it. A few dollars in legal fees could save you a great deal later on.

Contact Alice and/or Michele for literature on the subjects you'd like information on. They are experienced billers and have years of real world experience. Theirs is the best IMHO

Starting Your Own Medical Billing Business / Re: Started the process
« Last post by PMRNC on February 22, 2018, 06:58:06 AM »
Alice and Michele the owners of this forum have a good book on how to write a contract!
I also own PMRNC which is a medical billing resource and networking association at we have a lot of resources for those starting and running their business.

You want to also make sure you have a good compliance plan and HIPAA Business Associates Agreement.
Starting Your Own Medical Billing Business / Started the process
« Last post by Kinlaw30 on February 21, 2018, 09:48:18 PM »

I have started the process of my own medical billing business and hope to get started soon. I have registered the business name and started working on a contract. What would be some things to include in a contract? I also would like to know what books would be helpful when starting the business?


Are you still looking to fill the position?
I am new to claims filing and I was wondering did you ever get the correct revenue code for residential MH facility room and board? Any help would be greatly appreciated. Thanks Trent
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