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Insurance Payments / Overpayment scenario
« Last post by Hfitting18 on Today at 10:07:56 AM »
I am very new to this position and am learning as I go. Not sure how to proceed here - a personal injury patient's auto insurance covered 80% of our claim. I submitted to BCBS for secondary, they covered 100% of the allowable amount resulting in a total payment of $256.26 on a $210 claim.

Here is a detailed breakdown of remits:
Charge $210
Auto paid $168
Patient CoPay due $42
Submitted to secondary
BCBS paid $88.26
Contractual Adjustment of $121.74

I think BCBS didn't take the prior payment information into consideration? Any direction is greatly appreciated :)
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Medical Billing Software Reviews / Re: Looking to change software
« Last post by mdvision on Today at 08:50:28 AM »
mdvision  EMR is the top rated EHR and Medical Billing Software within your budget ONC Certified
https://mdvision.net/white-label-pm-emr.html
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Billing / Re: Billing under supervisor for Blue Cross Blue Sheild
« Last post by s0b3k111 on Today at 02:41:29 AM »

I'm not sure what you mean by this.  Don't you bill all services at the same fee and then let the insurance carrier process at the appropriate rate?

Well, previously (and probably incorrectly like I said), all of our LMSW/LPC/LLP billing was done directly under the LP's NPI number (only for BCBS). So we received the rate for an LP. So we did bill at the same fee, but we didn't include modifiers to indicate that there was a lower licence level because our (mis)understanding was that we were able to bill under the supervisors lisence.


Quote
Are you in Michigan?  Are you referring to the BCBS PGIP?  If so, you would have to check with BCBS to find out if you can avoid it.

Yes we are in Michigan, and since we do not participate in any physician organizations, so is there a way to not be forced to pay this fee?


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Most medical offices set a fee schedule for their services.  All services should be billed at that fee schedule and then adjusted according to the EOB/ERA.  It is common for offices to set a fee schedule anywhere from 125-160% of Medicare allowed amounts for their area, even if they do not enroll with Medicare.  It's a good gauge to use when setting fees.  For example, if Medicare allows $67.56 for a 90834 the a common fee might be $95.    I hope this is helpful!

So for us we bill at different rates depending on the insurance (again not sure if that is wrong or not). Aetna at 125, BCBSM at 145, Medicare at 105 etc. Each company has a slightly different cost. I hope that explains it more clearly, and yes you were helpful.

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Billing / Re: Billing under supervisor for Blue Cross Blue Sheild
« Last post by Michele on August 14, 2018, 01:14:29 PM »
I am wondering a few things:
Is there a way to bill at the LP's rate legally

I'm not sure what you mean by this.  Don't you bill all services at the same fee and then let the insurance carrier process at the appropriate rate?

Is there a way to avoid PGIP, we are not a part of any physician group, and have not been previously charged this.

Are you in Michigan?  Are you referring to the BCBS PGIP?  If so, you would have to check with BCBS to find out if you can avoid it.

If the BCBS max allowable for our practice is $160 for LP should we bill $160 or slightly under?
Why is this information so hard to find?

Most medical offices set a fee schedule for their services.  All services should be billed at that fee schedule and then adjusted according to the EOB/ERA.  It is common for offices to set a fee schedule anywhere from 125-160% of Medicare allowed amounts for their area, even if they do not enroll with Medicare.  It's a good gauge to use when setting fees.  For example, if Medicare allows $67.56 for a 90834 the a common fee might be $95.    I hope this is helpful!

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Billing / Billing under supervisor for Blue Cross Blue Sheild
« Last post by s0b3k111 on August 14, 2018, 06:42:00 AM »
Preface: I am not a medical biller, we have recently let go of our biller and I believe that she was not doing her job correctly.

I help manage a psychological clinic (7 LP, 3 LLP, 5 LMSW, 5 LPC is the licensure breakdown), and previously we billed all of our blue cross claims under our LP's only. They provide direct supervision for all of the clinicians that we submit claims under them for. Our most common CPT code is 90837 as a standard appointment is 60 min for us.

I am wondering a few things:
Is there a way to bill at the LP's rate legally
Is there a way to avoid PGIP, we are not a part of any physician group, and have not been previously charged this.
If the BCBS max allowable for our practice is $160 for LP should we bill $160 or slightly under?
Why is this information so hard to find?
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Starting Your Own Medical Billing Business / Re: Vacation and Time Off
« Last post by LoveBilling on August 13, 2018, 01:29:31 PM »
Thank you Michele. That's what I was thinking as well, make myself available by having phone and laptop to connect to what I need. Was curious how others handle these situations since it seems like there are a lot of solo billing company owners out there. Question came up to me as I begin writing my compliance and P&P.

I do have someone that will be available to help when I get started, I'll keep in mind and train eventually to cover for me when it gets to that point.

Thanks,
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Starting Your Own Medical Billing Business / Re: Vacation and Time Off
« Last post by Michele on August 13, 2018, 09:37:37 AM »
That is a tough one.  If you are the only one at your business you've got an issue.  Either your clients have to be understanding, or you have to make yourself available.  One of the things we say when we are meeting with a potential client is that they don't have to worry about an employee calling in sick, going on vacation, or being out for surgery.  But we have people available to cover each other.

When we first started out and it was just Alice and I, we made ourselves available even when away.  Since we are mother and daughter it was not uncommon for us to go away together.  We just carried our cell phones with us and had a lap top so that we could connect to our system.  We would answer the call and just tell them we had to look it up and get back to them.

The only other option I can think of is to have someone cover you, if you have anyone that could do that. 

Unfortunately there is no magic answer.  Hopefully you will have understanding clients. 
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General Questions / Re: New member question(s)
« Last post by uiucspeech on August 13, 2018, 08:54:27 AM »


"I have not heard of being able to leave box 24J blank.  You did not mention the individual insurance carrier that you are talking about however I do not know of any insurance carrier that would allow the rendering provider information to be left blank for ST.  You could try it, but I would expect a denial."

The particular insurance company who told us to bill under the group rather than the individual provider was Health Alliance. I asked them if I needed to leave the individual NPI completely off of the claim form and they indicated yes. Then, when reading the instruction manual from NUCC for the 1500 Claim Form it stated "Report ID# in items 24I and 24J only when different from data recorded in items 33a and 33b." So I put the group NPI in 32a and 33a (33b I use the modifier ZZ along with our taxonomy code). This did result in a denial but they were basing it off of the provider not being in-network. I contacted them via phone and after some discussion they indicated they were going to process it back through and approve it. They did do that. There advice to me to ensure getting an approval was to use our Tax ID. I use that on all of my claims I submit no matter which insurance company I am sending it to. I feel at a disadvantage as I have never worked as a medical biller and have absolutely no training. I considered seeing if I could get my employer to pay for training for me but after reviewing different options for this training, I have determined that they will not believe it is cost effective as medical billing is a very small portion of my job and I don't even have to figure out the codes myself. I am going the ICD-10 codes and CPT codes for every single patient we do billing for. I just have to muddle my way through and hope I can catch on to some information that will make my claims more successful!


"Since you are a group of STs I would try to get the auth under the group instead of the individual therapist.  It would not be uncommon for a situation to arise where a different therapist within the group treated the patient.


I hope that is helpful!"


I am going to look and see if I can get the authorization under the group as often as possible. I think that is an excellent suggestion! I do appreciate your response and it was definitely helpful to me.
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Starting Your Own Medical Billing Business / Vacation and Time Off
« Last post by LoveBilling on August 12, 2018, 09:26:24 PM »
For those who are running their billing business alone without a partner, how do you handle vacations and emergencies where you can't be available to the providers if needed during normal business hours? TIA
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Billing / Re: DSMT and MNT Questions
« Last post by tperian on August 10, 2018, 07:17:57 AM »
Thank you.  That is what i was unclear about.  It DOES have to be provided directly by an RD. 
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