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Billing / Place of Service
« Last post by PsychBiller on February 14, 2018, 09:40:01 AM »

Is the POS code on a claim where the patient is located? or where the doctor is located?

example: if a doctor is present in their office, but is seeing a patient via telehealth who is located in their own home, which POS code would be correct?
Facility Billing / Re: Negotiation for out of network facility claim.
« Last post by HPATEL on February 14, 2018, 07:39:45 AM »
Actually, Linda, I would prefer negotiating with them so the patient won't be liable for anything after their ded and oop. That is why I wanted to know before we take an assignment.

Thank You
Billing / Re: DBT Billing
« Last post by Michele on February 14, 2018, 07:04:13 AM »
Do you have a BCBS Provider rep? They should be able to tell you if something has changed.  At the least point you to documentation.  I know they are not allowed to tell you how to code but if something was paid previously but is not being paid now they should have an explanation.  I bill for several LCSWs but we have not used the modifiers TG or XE.
Billing / Re: Collection Agency Recommendations
« Last post by Michele on February 14, 2018, 06:57:59 AM »
Wow, I am very surprised.  We have a great collection rate with them.  Do you have a rep that you deal with?  I would think that they would be willing to work with you to see why the collection rate is not good with you since their nationwide average is high.
Coding / Re: OT 97165 and 96111
« Last post by Michele on February 14, 2018, 06:54:50 AM »
I have not billed those codes together but I would have billed the 97165 as the primary CPT with the 96111 using the 59 modifier.  (I am not a certified coder)  I would not have put the 59 modifier on both lines. 
General Questions / Re: Medicare Modifier Help, Please...FY, TC specifically
« Last post by Michele on February 14, 2018, 06:51:02 AM »
Wow, that is interesting.  I have not ever had a situation where the order of the modifiers made a difference.  Hopefully this straightened it out for you!
Facility Billing / Re: Negotiation for out of network facility claim.
« Last post by PMRNC on February 14, 2018, 05:35:12 AM »
Right, carriers are not allowed to give out U&C. You have to fly blind sort of. Remember though you don't have to negotiate rates, anything above U&C can be billed to the patient if you do not have provider contracts.
Starting Your Own Medical Billing Business / Re: Patient collections
« Last post by PMRNC on February 14, 2018, 05:34:02 AM »
My full practice management contracts include "soft collections" which includes one phone call on balances outside 60 days, after that the provider makes a decision on how to handle.

Make sure you research state laws on this as well as the FDCPA ;)  Also make sure your contract clearly states your process of "soft collections" and the process of what happens if it does not work.
Starting Your Own Medical Billing Business / Re: Unexpectedly got my first client today
« Last post by PMRNC on February 14, 2018, 05:31:33 AM »

You mention the practice is designated practice for WC.. with that in mind, yes there is probably a lot of  money out there, but if I were in your shoes, I'd not go a % of collections on this type of client with heavy'll wait and wait and wait for your money. A lot goes into WC and a good process has to be established, you want to find out what process they have. For example, are they sending letters requesting LOP's? How does WC claims work in your state, etc.

Next, as I've mentioned in many posts in the forum, you want to transfer data to your system? That's a question you can ask your software vendor, but it's still a conversion none-the-less and those are NEVER fun and can be costly. INSTEAD why not take him on as a trial, forget the the independent contractor situation and take him on as a client and remote into his system for a while and see how it goes before undertaking a conversion on top of trying to figure out the numbers. I'd also make sure you get a setup fee to accomodate the time it will take to gather the information you need. They don't sound too organized so I wouldn't hesitate to make this setup fee a little hefty but discount it (wink) if they sign your contract by XX/XX/XXXX

Make sure your contract covers everything the practice is responsible for providing you, that will also cut down on the time. If you are local, you can put in the contract that you will make the necessary trips to their office to gather what you need. Same for picking up billing/eob's, etc.

This is a great first client, If it were me I'd ditch the whole IC thing as it's a tax headache for both of you and work as a business owner so that you can establish your business right. :)  Just my 2 cents. :)
Starting Your Own Medical Billing Business / Unexpectedly got my first client today
« Last post by squarepeg on February 13, 2018, 07:19:54 PM »
I wanted to start my own medical billing business yeaaaars ago.  I bought the books from this site and everything.  After a few more years experience and frustration from working underneath people, I decided to advertise my services as an independent contractor.  I figured I would get my company name out there and network through part time freelance work. 

Long story short, I sent my resume and cover letter to someone looking for a part time biller.  I went in for an interview with him today.  I really didn't know the details of what he wanted me to do, but it just sounded like part time billing from home and going in the office a couple days a week.  Ends up he was impressed by my experience enough that he felt I could possibly do the entire revenue cycle.  Actually, after seeing how mixed up he was, I kind of suggested it.  Plus, the little voice in my head was yelling at me to take this on. 

But I am not prepared for this, not really.  I've done my time in medical billing and wanted to concentrate on consulting.  But here's the situation at hand:  He has 8 doctors (soon to be 10).  His docs are designated physicians for workers comp cases, therefore he is legally owed the money for his services.  His problem is that he doesn't have time to collect and see what's going on. 

He didn't know what a PM system was, EMR, or anything.  He couldn't exactly tell me how much his practice makes monthly (he kind of just threw out $50,000 at me).  He didn't really know what a clearinghouse was.  He has a clearinghouse now but it's RIDICULOUSLY INEFFICIENT.  With all this information, it was difficult to hide my shock.  But he wants to hire me on as a contractor.  I told him I would accept 10% of collections, claim submission and tracking would be a different fee, as will be monthly reporting.  I have a feeling I will be downloading Office Ally in place of whatever he has now.  He just needs someone with some sort of "know how" around insurance.

It all sounds like a slam dunk, but omg....

Are there any suggestions on how to price monthly reporting and calculating consult fees?  Monthly reporting is more accounting work than showing my work for the past month.  The fact that he really doesn't know how much he was bringing in monthly and that he doesn't know how to use excel is insane to me... and I can't work with that.  We'll see how that all pans out but I would appreciate any advice or similar experiences.  I have a habit of biting off more than I can chew, and I have a feeling that's what I may be getting myself into.   

Being that I wasn't prepared for something like this, I am a little gun shy of spending a ton of cash.  But if I wanted to take the data from their system (which seems like some makeshift customized program in outlook) how would I transfer that to a software like totalmd?  How does the transfer from PM systems usually happen?  I don't want to do this too quickly because I don't want to scare them off with a ton of new changes when I'm not even in the door yet  :-\
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