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Billing / PT Billing/Modifiers
« Last post by lacycr on May 02, 2018, 01:41:16 PM »
I have done Chiropractic billing for several years but my office is expanding and has hired a physical therapist as well. Billing for PT is new to me. I know there has been some changes to PT new patient visits CPT codes last year. Can anyone clarify for me what codes you bill for the different levels of new patient visits? Are any modifiers needed for PT exams? If so, what ones? Thank you! (Not for medicare billing, this will be for commercial insurance plans)

If you're going to serve up email with a mail provider, your best bet is to do it like the big kids do it.

Namely, look at Google and Amazon.

Yeah you can set up your mail with Azure as well, but we've had trouble with their interface in the past and walked away from Microsoft's platform.

Google G-Suite is reasonable to configure (translation, you'll only lose about as many days from your life as eating McDonalds for a month straight), and Amazon Web Services (AWS).

We use both.

Here are the links to their HIPAA compliance processes (G-Suite, AWS)

If you're new to infrastructure setup, you'll do better with G-Suite because the configuration is more intuitive.

1. If you already have a URL served up by a DNS host (like GoDaddy for example) then make sure you can get into your zone file, that's where the magic happens.
2. In G-Suite, set up your new domain first - important.
3. Verify your domain with G-Suite. (domain verification is easiest if your DNS host is GoDaddy, but doable with dozens of others...NOTE: DreamHost is hit or miss, so....)
4. Setup your new user on G-Suite
5. Make certain your MX records are setup correctly on your DNS host (this should be done automatically by G-Suite but it pays to check)
6. Enjoy your new business email hosted by G-Suite...

That's it...


Coding / Re: cpt 11306 blue cross blue shield of texas
« Last post by dtillotson on May 02, 2018, 01:13:39 PM »
It is two separate warts, thank you. I have added the 59 modifier, and am submitting it by paper with a copy of the notes and a reconsideration form.
Billing / Re: Percentage-based billing agreements are not illegal in California
« Last post by PMRNC on May 02, 2018, 08:29:38 AM »
a billing company would have to accept whatever the  market bears or look for another type of business.

Yes, and I've never had a problem telling a new client this by presenting a realistic approach. I ask them if they have an accountant and there answer is usually yes, and then I ask them if they pay their accountant a % and they usually say "NO WAY" ...point scored for me. Same goes for any service business. Next point, I ask them if they hired a marketing firm to bring in new patients would they pay them a % and 9 out of 10 providers are smart enough to know that would violate the anti-kickback statute and referal laws. Another point scored. Then I ask them, if you hired 2 billers right now that would do the work of what I would do as my own company with my own liability and insurance and costs, would they pay that employee a % of revenue? Answer is obvious what they will say.

Bottom line is that business owners can be in charge of market demand simply by being straight up with a provider and making their case. I'm in the state of NY. 8 out of 10 providers KNOW the law is extremely clear and HAS been challenged UNSUCCESSFULLY so they already know they can't engage in fee-splitting under any circumstance. The billing companies here that do charge a % are NOW begging for work because they have not changed their billing methods and doctors are way too educated now to know that if they are solicited by a billing company from any state and even offshore (This is probably why we don't have a huge problem with offshore outsourcing because the don't know the law here is for the DOCTOR, not them and would stand in a court of law) that wants to charge them a % they flat out can't do it. NY and Florida probably have the clearest rules regarding fee-splitting so it's easy in these states to explain to providers that don't know, it's only one paragraph to show them and that in turn allows the right billing company to show they care about their clients while protecting their own contracts. Those doctors that do it anyway and those billing companies that do it any way both lose. The provider can be sanctioned or worse, and the billing company's contract RETROACTIVELY for that provider is NULL/VOID.

I didn't go to business school, but I don't think in business rules are that black and white and I think business owners can decide the market value by standing up for their business and their business models along with educating their clients ;)
Starting Your Own Medical Billing Business / Re: Marketing Question
« Last post by markatMBH on May 02, 2018, 07:30:00 AM »
Hi ShelbyLMK,

Few business activities have caused more failure and pain to business owners than “marketing”...

...pain that usually comes as a result of certain myths and misconceptions that the entrepreneur often starts out having, even before the business is created.

These marketing myths are a bigger problem than you might think, because they cause you to make very costly decisions, take you down the wrong path and can even lead to the whole operation shutting down.

You’ve heard that the number one reason small businesses fail is that they run out of cash.

But you hardly ever learn why.

Small businesses run out of cash because they use it to chase the wrong audience in the wrong way.

The good news is that these myths are fairly easy to dispel.

My own misconceptions were slowly (and I must say not completely, good heavens!) dissolved by many early, and even later failures over the past 30 years.

As the old adage goes “Failures are just practice shots.” So not to worry when failure happens – simply keep going.

So, a few items here about your marketing and your billing business because how you market is the difference between success and failure...not only for your own billing business of course, but in reality for any business.

If it wasn’t true that marketing is among the most important business functions, and the one that determines business success more than any other, marketing budgets would not be as high as they are, and marketing people would not be compensated the way they are.

You see, Fortune 500 companies in their B2B services lines typically spend 12%-15% of their total budget on marketing - and large cap startups spend over 20% of their annual budget on marketing.

Take a moment and think about how high that is...

By the way, that percentage increases as the annual revenue of the business decreases – which appears strange but makes sense since smaller businesses have taller hurdles to jump in trying to reach their audiences.

These large numbers simply would not be the case if the marketing function did not return some multiple of the money spent.

Now, a startup service business such as your billing service should expect to spend north of 15% of your budget on marketing, especially when you’re starting out.

(There are rather successful specialty medical billing services whose ad spend alone is 20% of budget...and that’s because the return is significant otherwise there’s no reason to spend the money in the first place).

[If you want to actually see how important marketing is to startups, go to and look at the ad and marketing budgets of newly funded businesses.]

Your marketing spend is an important number, because in it you must already have the critical component numbers such as expected cost of client acquisition and lifetime (sometimes annual) client value accounted for.

Here’s a hypothetical: say that you acquire a new client, a dermatopathologist (single provider) whose annual charges are $1.25M and for whom, after a year of billing for her, you collect 40% (so gross collections of $500K), and whom you charge a gross collection fee of 8%. So, for the year your billing service earned $40K in revenue from this client. Again, all hypotheticals.

Now, the question is, “How much would you spend to acquire this client?

Truthfully, this is a bit of a difficult question to answer unless you have organized your business’ value chain / value ladder and have articulated even a rudimentary operating plan.

Nevertheless, the question illustrates the fact that there are certain timeless principles of marketing and business development.

The purpose of these principles is to attract and delight your prospects and customers. And that these can be measured, in a rational, organized way.

These principles are very valuable to learn before you spend your money on this or that technique for acquiring customers, and there are excellent resources all over the place (the interweb) where you can learn those principles without much hassle.

Where to begin.

For the classic principles you can hardly go wrong with, Dan Kennedy (the recognized father of direct response marketing) and Jay Abraham (the godfather of the entire field as it is currently practiced).

From there you’ll learn about many more who can teach you how to think about, how to plan, and how to deploy your marketing assets.

There is an entire crop of what the older folk call the online marketing wizkids. The best of the best reside in niches:
For organic (“free”) traffic growth - Neil Patel
For Google Ads - Perry Marshall
For Facebook Ads - Keith Krance
For beginner guides of various topics, one of the most helpful is Miles Beckler. Miles is kind of “new” - he’s only been doing it for about 10 years (wink).

Firstly, “marketing”, like your other business functions is best thought of as an ongoing activity of and for your business.

The actual purpose of this activity is to produce marketing assets that return real results such as, email optins, leads, and sales.

In fact, if you’re a business owner there’s no escaping the fact that you are a marketer. So congratulations on that! (where’s that smile emoji?)

And your job as a marketer (I mean, business owner) is for your prospects and clients to feel completely understood.

The best way to do that is to start an ongoing conversation with your audience.

This requires 2 things.

First, you must know your audience – and know them very well.

To do that, an important exercise for you is to develop your ideal client’s persona or avatar.

You can get this done in an afternoon.

Here’s a step-by-step guide by the number one organic growth marketer online Neil Patel. Others exist of course, but if you’re starting out this one is my favorite.

Second, you must understand the various media that you will use to start and continue that ongoing conversation, and (here’s the most important part) pick one, and go all in with that medium or one of its channels.

How do you choose which medium to focus on, and or which channel?

( In deference and respect for the forum I’m going to pause here since my reply to you has already passed the thousand word mark. Let me know by replying in here if you want me to continue my comments to you and I’ll be happy to continue with examples…)

The basic lesson taught in Business schools is that in a free market system, you do NOT set your rates, you charge what market will bear. In our business, the Providers feel that paying the billing company is an unnecessary expense.
They will pay the least they have to.
Whether the percentage billing is good or bad is irrelevant; a billing company would have to accept whatever the  market bears or look for another type of business.

I would agree that charging by percentage may be a " horrible " way of doing business, but that is the way it is.

With regard to billing business a good or bad business with the percentage model, the stats are that it is a tough business to say the least. Most billing companies lose money. They can't cover their basic expenses.

The merchant account companies, who solicit every business, hang up when you tell them that you are a medical billing company; they are not interested. I was told that we are a " high risk business" along with escort services and cannabis growing; the failure rate to be very high, almost 100%.
We pay a premium for our credit card merchant account like every one else here, because so many go under sooner or later, leaving the merchant account companies high and dry.

In short accept the percentage fee as a fact of life, and congratulations if you are still here and not decided on an alternative career.
The Court case is good news, at least there is no legal barrier to what is norm.

By the way the New Jersey company that you mentioned that charges 4% is a public company, they ran up a  loss of $12 million in two years. So much for the profitability in this business.

All of this is for one reason; the Provider will not pay any more money or anything other than a measly percentage fee.
« Last post by PMRNC on May 01, 2018, 01:22:00 PM »
Are these ERISA claims? If so that might make a difference with timely filing.
Coding / Re: Genetic Counseling
« Last post by PMRNC on May 01, 2018, 01:20:56 PM »
In most cases it's NOT covered. Even with cancer patient's such as myself where the genetic testing itself determines treatment it's not covered. In many cases cancer facilities and hospitals will have avenues for reimbursement due to grants and cancer organizations.

For testing, no it's NOT a normally covered service, but you could verify benefits for the testing to be sure. Genetic counseling and testing is still NOT fully considered medically necessary is the reason why it's normally a non covered benefit.
Coding / Re: Genetic Counseling
« Last post by Michele on May 01, 2018, 01:17:40 PM »
You can submit the charges, it will depend on whether or not the insurance carrier or the plan covers the services.  I would think you would bill the patient if not covered by their insurance, unless the provider is contracted with the insurance carrier and can't bill the patient per the contract.  But if the services aren't covered, usually the patient can be billed.   I have not ever billed for genetic counseling. 
General Questions / Re: Dental Billing
« Last post by Michele on May 01, 2018, 01:14:36 PM »
I haven't used any dental software in years, and the one we used no longer exists.  Sorry, I don't have any recommendations.
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