Medical Billing Forum
Billing => Billing => : Christy January 17, 2013, 01:40:16 PM
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Upon submitting claims for a new client to Medicare- what type of notification do I have to give to Medicare? Will there be a delay in claims pmts?
what if I use their current software/clearinghouse? Does it matter who presses "go" to send the claims to Medicare?
thanks!
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Whenever a provider adds, or changes a billing agent (you) they need to notify Medicare via form 855 or PECOS. Here's link, it will depend on what type of practice they are. http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/EnrollmentApplications.html You will need to do this even if you use their submitter ID's via their clearinghouse or your own, you still become the "billing agent". You also will still want to do your own HIPAA business Associates Agreement as well.
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Does this need to be done for an outpatient mental health co.
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Any provider that bills Medicare and uses an outside billing company needs to inform Medicare of the change in billing agent.
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I have now read that a billing company (at least in NY) has to be registered with Mediciad to submit claims to them? has anyone else heard this?
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I have now read that a billing company (at least in NY) has to be registered with Mediciad to submit claims to them? has anyone else heard this?
Yes, it's required in NY. I don't remember when it came into play but you must be registered as a third-party billing agency and agree to all the rules/regulations. Too much Medicaid fraud happened in NY and this was one of the responses. If you google "billing agencies submitting claims to Medicaid NY" or something similar to that, you will find their PowerPoint presentation (I believe it's PP and not a PDF), which is pretty informative. They will ask for your policies and how you charge for your services (obviously can't be percentage based). It's mostly a painless process as long as you submit a completed application with all the proof they need. They also list you or your company's name (however you run your business or submit on the app to them) on their website of approved third-party billing agency who can submit to NY Medicaid. If you goto the NY Medicaid site this list is somewhere on there of current approved third-party billing agencies who can submit to NY Medicaid.
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thanks, Dee! you are a tremendous help! ;D
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Dee is Correct in NYS Medicaid guidelines
http://aishealth.com/archive/nmcn0211-01
The original thread was in regards to Medicare so I just want to clarify that. :)
Also There is a confusing grey area in regards to the NYS law and the ACA , specifically it mentions in that link I gave, to : "Sec. 6503 of the health reform act called for medical billing companies to become registered." I have seen this on several other forums/social media and it's confusing because Sec 6503 of the ACA states:
SEC. 6503. BILLING AGENTS, CLEARINGHOUSES, OR OTHER ALTERNATE PAYEES REQUIRED TO REGISTER UNDER MEDICAID.
(a) In General- Section 1902(a) of the Social Security Act (42 U.S.C. 42 U.S.C. 1396a(a)), as amended by section 6502(a), is amended by inserting after paragraph (78), the following:
`(79) provide that any agent, clearinghouse, or other alternate payee (as defined by the Secretary) that submits claims on behalf of a health care provider must register with the State and the Secretary in a form and manner specified by the Secretary;'.
NYS has required third party registration if billing Medicaid, however IMHO SEC 6503 is a bit confusing as it says OR other alternate payees, leading you to believe it might only be those third party companies who are collecting the money. (alternate payee). One could also read that it's ALL billing agents.. PERIOD.. to which I have to scratch my head and wonder how each state is going to handle that one!! <sigh>
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thanks, Dee! you are a tremendous help! ;D
No problem and thanks, I try. I don't know everything, but I went through this process so I knew. :)
Not to go too off topic, but you'd be surprised how many doctors don't know this. Sadly, it's bad billing companies who continue to structure their contracts in a way that's illegal in NY when contracting with doctors. I can't tell you how many potential clients will argue me on this, then I give them proof, and they go to their attorneys and come back with that "you were right" conversation. I always say it's not about me being right but us both starting out from an informed and legal perspective. I really wish I could banish the amount of misinformation out here, but it's up to all of us to know and Medicaid in NY, I know.
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Not to go too off topic, but you'd be surprised how many doctors don't know this. Sadly, it's bad billing companies who continue to structure their contracts in a way that's illegal in NY when contracting with doctors. I can't tell you how many potential clients will argue me on this, then I give them proof, and they go to their attorneys and come back with that "you were right" conversation. I always say it's not about me being right but us both starting out from an informed and legal perspective. I really wish I could banish the amount of misinformation out here, but it's up to all of us to know and Medicaid in NY, I know.
SOOOO True!! Same goes with the fee-splitting laws! So many billing companies and DOCTOR's just think because everyone else does it.. it's ok. On other hand it's a great marketing tool when you advise a potential client of something their previous billing company didn't!