Medical Billing Forum

Starting a Medical Billing Business => Starting Your Own Medical Billing Business => Topic started by: kkelley831 on July 03, 2014, 01:11:29 PM

Title: New to billing
Post by: kkelley831 on July 03, 2014, 01:11:29 PM
I am new to the insurance world. I have read up on the CMS 1500 form so I know very little. I work for a non-profit that is starting to look into billing insurance companies for our mental health services. Where do I start? What type of licensing is required for our therapist to bill insurances?
Title: Re: New to billing
Post by: rdmoore2003 on July 03, 2014, 01:23:12 PM
You have to credential and become networked with insurances.  What type of providers are they? LPC's, Ph.D's etc?  Are you a facility or professional?
Title: Re: New to billing
Post by: kkelley831 on July 03, 2014, 01:36:20 PM
We currently have a PhD on staff. We have a counselor who is NCC but is getting licensed and an MSW with a temp Licensed but is also becoming licensed. We are a facility.
We have to be credentialed and become networked before we can do any type of insurance billing, correct?
Title: Re: New to billing
Post by: PMRNC on July 03, 2014, 01:50:36 PM
Quote
We have to be credentialed and become networked before we can do any type of insurance billing, correct?

Not necessarily...To be participating you need to be credentialed.
Title: Re: New to billing
Post by: kkelley831 on July 03, 2014, 02:56:29 PM
So I do not have to be participating in order to bill the insurance? I am completely new to this so any information is helpful.
Title: Re: New to billing
Post by: PMRNC on July 03, 2014, 03:07:33 PM
Quote
So I do not have to be participating in order to bill the insurance? I am completely new to this so any information is helpful.

You bill carriers as "non par"  but you will want your patients to know they need to pay up front. You will still also need to get authorizations where needed or at least make sure the patient gets them and brings them in.

I don't want to sound rude, so please take this with the spirit to which it was intended.. if you have not done this before, you need to let someone who has take over at least until you can obtain proper training. This is not a business you want to muddle through as you go along and hope for the best.
Title: Re: New to billing
Post by: kkelley831 on July 06, 2014, 03:16:54 PM
I appreciate your help. I work for a non-profit so this is a new world for my agency. I am definitely seeing that there is much more to this than I can teach myself. Do you have any recommendations on a training?
Title: Re: New to billing
Post by: PMRNC on July 06, 2014, 04:35:26 PM
Take a look at www.medicalbillignstudycourse.com

Title: Re: New to billing
Post by: kkelley831 on July 07, 2014, 06:17:27 PM
Thank you, i will look into this. Another quick question, I think I already know the answer though. In order to bill for therapy services do those providing the service have to have a license? Currently they have credentials to provide services but they are master degrees and trainings not licensed (LPC or LGSW, LSW, LCSW). 
Title: Re: New to billing
Post by: rdmoore2003 on July 08, 2014, 11:07:07 AM
What state are you in?  If your provider is not licensed yet, you need to check your states supervision requirements.  Since you have a PhD, your unlicensed providers may fall under the supervision of the PhD.   You must check with your state's supervision requirements first.     In regards to filing insurances, if you file as non par, typically patients want to use a participating provider with their insurance.   Benefits vary greatly between par and non par providers.
Title: Re: New to billing
Post by: kkelley831 on July 11, 2014, 02:49:09 PM
I am in West Virginia. I will look into the supervision requirements. Thank you