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Billing / Medicare Orthotics & Prosthetics Billing
« Last post by mandaree23 on Today at 02:02:00 PM »
I have just taken on the billing for an O&P group who has had very bad luck with their billing.  They outsourced billing 4/1/16 and they are now bringing back in-house and I have a lot to clean up.  I have come across SEVERAL Medicare claims that there appears to have not been touched.  It shows the claims were sent to Medicare in late 2015 and early 2016 but nothing beyond that.  There are also several that the billing company followed up on and just noted no claim on file but failed to file, despite the fact there was still time to do so.  I am no longer to obtain proof of timely filing through Emdeon so I just have the date notated in Futura showing when it was billed, rebilled, etc.  Some of the claims I may have a written log in the chart.  I am unable to rebill these claims in the old system. 

Does anyone know if I am able to get these claims paid if I have proof of timely?  If so, am I able to send paper claims with proof of timely?  ANY help would be much appreciated.   :'(
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First of all, congratulations on getting them overturned!  Good work!

So basically they did overturn and pay but the provider does not want to accept the amounts, correct?  If the provider is out of network they can bill the patient for the amount above what the insurance carrier allowed.  I'm not familiar with CollectRX in particular but it appears they are a revenue cycle management company.  Since you already did the work of getting the claims overturned it seems like you might not need a full service like them.  Have you tried billing the patient yet?  I would try billing first on my own.  If the patient indicates they aren't going to pay, or doesn't respond, then I would do something more like collections.  We use a soft collection agency that has great results.

Thank you! It was hard and I learned a lot. Even the rep at the AG's office was surprised at the outcome.

Yes, that is correct. We are billing the patient for the ded and coin. we can balance bill but the provider wants a larger allowed amount. In the past, Viant has negotiated with us, this time they are basically saying if it's covered under ERISA, try your luck there or bill the patient.  We have used Collect RX to get larger payments for past out of network claims. The provider will  not use a collection agency, I am the collector and if it gets to a point, we take delinquents to small claims. I would much prefer a collections agency!!

Thank you for your response. I wanted to see if there were any options other than billing the patient before presenting the bad news to the provider.
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First of all, congratulations on getting them overturned!  Good work!

So basically they did overturn and pay but the provider does not want to accept the amounts, correct?  If the provider is out of network they can bill the patient for the amount above what the insurance carrier allowed.  I'm not familiar with CollectRX in particular but it appears they are a revenue cycle management company.  Since you already did the work of getting the claims overturned it seems like you might not need a full service like them.  Have you tried billing the patient yet?  I would try billing first on my own.  If the patient indicates they aren't going to pay, or doesn't respond, then I would do something more like collections.  We use a soft collection agency that has great results.



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I wanted to give an update, the IRO was successful and they overturned all the claims. THANK YOU ALL for your responses, it helped me tremendously as this was my first claim to take all the way. I have a question, hoping someone can help me.

The provider disputes the Out of Network allowed amounts. I went through the proper channels and disputed the payments as they were repriced by Viant. Viant is saying they are not willing to negotiate. My question is can I send these claims to a CollectRX type company? Ssince these claims were paid by overturning I don't know if that would make them ineligible or not?

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Medical Billing Software Questions / Re: Accessing Provider Software
« Last post by Michele on October 18, 2017, 06:31:25 AM »
I'm waiting for my IT guy to come in.  He is supposed to be stopping to give me my options.  I told him I don't want to keep using the logmein for that price.  I use one seat, Alice uses one, my operations manager and my office manager, and we have one client on our account.  I'd probably find a reason to use 10 seats if they weren't so pricey!
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Medical Billing Software Questions / Re: Accessing Provider Software
« Last post by PMRNC on October 17, 2017, 07:01:34 PM »
I only have one seat and my cost is included in my clients fees. They did get pricey since being bought out. I'd prefer a VPN myself but can't really say the costs would be worth it for me since I don't have (or want) employees.
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Medical Billing Software Questions / Re: Accessing Provider Software
« Last post by Michele on October 17, 2017, 06:36:17 PM »
We have used logmein for years as well.  However they are getting very pricey.  We have 5 seats and in January they will be charging us over $700.  Their fee has doubled the past two years in a row.  I can't continue to pay those rates when we can do a VPN. 
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Medical Billing Software Questions / Re: Accessing Provider Software
« Last post by PMRNC on October 17, 2017, 04:02:10 PM »
I use LogMeIn as it has the best in security features with two factor authentication PLUS you can actually log in and out of the practice's computer (using your own login of course) . You can also boot and reboot the system if you need to.
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Medical Billing Software Questions / Re: Accessing Provider Software
« Last post by Michele on October 17, 2017, 09:23:07 AM »
You can set up a VPN (Virtual Private Network).  That has to be done by an IT person.  Other than the charge for the IT person I don't believe there are any costs.
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Medical Billing Software Questions / Accessing Provider Software
« Last post by Chiro Billing Collect on October 17, 2017, 09:06:48 AM »
If a doctor does not have cloud based billing software, how are you accessing the program? I have used Go To My PC but am looking for different options possibly without a fee.

Interested in learning more of the logistics of remote billing if you use the provider's software.

Thank you.
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