Recent Posts

Pages: 1 [2] 3 4 ... 10
11
New! / Credentialing a New Teletherapy Company- HELP
« Last post by Jmojica on December 07, 2017, 12:08:56 PM »
Hello Everyone,

I hope everyone's Holiday was relaxing and will be joyful.

I need your opinion/advise/guidance.

A new Teletherpay mental health organization (NY) needs to get credentialed and asked me for help. The owner herself isn't a licensed professional but he servicing providers are licensed. How will I go about credentialing the organization as a group versus just credentialing each of her providers?

Any help you can provide would be helpful. I've googled this topic with no results.
12
Billing / Re: Does anyone currently bill Tricare for a behavioral health facility?
« Last post by Michele on December 07, 2017, 07:34:21 AM »
Are you billing for all inclusive room & board?  What services are you billing for?  I know it's substance abuse facilities but the H0018 is short term residential without room & board.  So in order to answer you I need to know what services.  For example, when you bill all inclusive room & board you use a rev code such as 0128, depending on whether its detox or rehab and the type of room.

Have you ever completed UB04s?  They are a bit different.
13
Billing / Re: Does anyone currently bill Tricare for a behavioral health facility?
« Last post by ghello12 on December 06, 2017, 04:19:31 PM »
It's an out of network facility. Do you just bill the standard H0018 code for residential? Or is there any different coding that you have used?
14
General Questions / Re: Seeking Medical Billers
« Last post by Michele on December 06, 2017, 09:52:07 AM »
I would say that's a no.  We've never received any responses.
15
Billing / Re: Does anyone currently bill Tricare for a behavioral health facility?
« Last post by Michele on December 06, 2017, 09:49:58 AM »
Are they in network with TRICARE?  TRICARE has Participating In Network, and non Participating in network.  It's important to know what they are.  Other than that it is similar to billing any other insurance.  I would recommend verifying benefits prior to treatment to make sure patient is covered, services will be covered, if auth is needed, etc.  They accept electronic submissions. 
16
Billing / Re: Podiatry billing question
« Last post by Michele on December 06, 2017, 09:47:28 AM »
Are you billing that on one line with 4 modifiers?  Or two lines with 2 modifiers each?  Are there any other codes on the claim/same date of service?
17
General Questions / Re: Seeking Medical Billers
« Last post by ariseandshine on December 06, 2017, 07:59:29 AM »
Has anyone been contacted by this poster and received any information on work?
18
New! / Re: UNITED HEALTHCARE UNDERPAYMENT
« Last post by PMRNC on December 05, 2017, 06:00:30 PM »
I know hindsight is 20/20 but whenever you have a high priced procedure to be done and you are NOT contracted, it's always best to request a pre-determination of benefits. This entails the CPT code, the amount to be charged and the diagnosis. Just like verifying benefits you want to determine what (if any) the patient's responsibility is.  The carrier will NEVER give you the U&C charge as that would be a pre-requisite for any provider to commit fraud, so your result from the pre-determination of benefits will be that the carrier will tell you that they will pay $XX for the procedure you will be performing.  When the procedure is done, the operative report/office notes can be used later if there are any particulars that could not be foreseen when the pre-determination of benefits was submitted which you could use in your appeal and/or request for additional payout.

WITH ERISA (non govt/church based group health plan) you must remember that the dept of insurance has NO oversight. It will NOT  be your appeal, it will be the patient's appeal. If the charge was $5000 and U&C from the carrier was $3000 the patient is responsible for costs above the U&C and any coinsurance as well. If you have the RIGHT AOB that includes ERISA verbiage you can appeal on behalf of the patient (standard AOB's are NOT good enough) you can sometimes manage to get MORE for the service by submitting an appeal as the patients representative. If your not willing to go through this process, the patient bares the burden of financial responsibility.

19
New! / Re: UNITED HEALTHCARE UNDERPAYMENT
« Last post by kita... on December 05, 2017, 02:31:05 PM »
Thing is, their Usual and Customary Rates are below state reg. And I don't know the exact verbiage that I can use to make them reprocess these claims for higher amounts that are necessary for services rendered.
20
Billing / Does anyone currently bill Tricare for a behavioral health facility?
« Last post by ghello12 on December 05, 2017, 10:42:00 AM »
I'm new to the forum and currently bill for substance abuse and mental health facilities. I have a program that is looking to start taking Tricare clients. Is there anything that I need to know or be aware of as I get into Tricare billing? Any info helps! Thanks!
Pages: 1 [2] 3 4 ... 10