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71
General Questions / Re: Incorrect Insurance Info-Who's responsibility?
« Last post by PMRNC on October 31, 2017, 01:28:31 PM »
My flat fees are done MONTHLY along with sliding scale. If for example I set mine at 6 patients (because six patient's might be what I can enter in one hour from demographics to claims) the provider is billed an additional $25 for every new six patients. So if they add 3 new patient's one month and three the next, the $25 is added on that next invoice with the sixth patient. That is just an example. I do both pediatric and mental health so with mental health I can easily do 8 patient demographics and claims in an hour where as with Pediatric it takes me a bit longer. You set your sliding scale based on your hourly rate. If you are just doing the flat fee and NOT accommodating the growth of a practice you will lose money well within six months. If the practice is one that grows you want to make sure you have a sliding scale to accommodate the growth (and time for you).
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Billing / Re: help! Value Options/ NYSHIP
« Last post by Christy on October 31, 2017, 01:21:13 PM »
VERY helpful!!!! thank you!!!!!

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Billing / Re: help! Value Options/ NYSHIP
« Last post by PMRNC on October 31, 2017, 01:19:44 PM »
I HAD this happen too, but with Magellan.

YOU have NO contract, NO previous contract, an error was made on THEIR part. That being said, right now you are OON. PERIOD.  You have every legal right to bill patient's for balances.

What we did in this instance was tell the patient (even though they were told we were non par at the beginning) that they may get EOB showing no balance due. We then attached that letter given to us from Magellan saying we were credentialed in error (same as you got) and sent patient a bill. We continued, in the meantime, to follow-up with Magellan making sure they fixed it on their end. They did, it took about three months too which upset some patient's but again, we told the patients up-front we were NON par. We also did not show up in any of their par provider books or listings (thank goodness).

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Starting Your Own Medical Billing Business / Re: Phone/Fax Business Services
« Last post by PMRNC on October 31, 2017, 01:15:17 PM »
I've not heard of S fax.. what is their website?
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Starting Your Own Medical Billing Business / Re: Phone/Fax Business Services
« Last post by Christy on October 31, 2017, 01:02:31 PM »
I love S Fax. It's electronic and they willingly sign a BAA. also VERY reasonably priced.
77
Billing / help! Value Options/ NYSHIP
« Last post by Christy on October 31, 2017, 12:59:59 PM »

I bill for a NY LMHC. She is INN with Value Options for MVP commercial only.  She is OON for NYSHIP via Value Options. She could not be INN for NYSHIP/ VO even if she wanted to be, as they don't credential LMHCs.

She has been seeing a few NYSHIP people for years. They pay her full fee upfront and we submit the claim as a courtesy not accepting assignment. NYSHIP always pays the patients directly. It's been working great for years.

In August, when she re-credentialed with VO, someone over there must have accidentally checked the "NYSHIP" box. She got a letter that she was "credentialed in error" with NYSHIP and would be "disenrolled Oct 29."

Now her claims for Aug and Sept (and probably Oct) are being processed in network and at the NYSHIP/VO dismal fees ranging from $38- $67. Her patients already paid her normal fees upfront of $110- $150. They've all met their OON deductibles and are expecting their 80% reimbursement checks.

We have called the credentialing dept NUMEROUS times and keep being told we need to wait for someone from the "NY Team" to call us back as they are very backed up.

The LMHC never agreed to a NYSHIP contract and never agreed to their fee schedule. Besides appealing the claims to the claims dept (and we all know the claims dept and the credentialing dept have no idea what the other do), what steps/ recourse can we take?

this is a ridiculous situation, and no one at VO will listen to our point of view and someone (either the provider or the patients) are going to lose a lot of money :(
78
General Questions / Re: Incorrect Insurance Info-Who's responsibility?
« Last post by Chiro Billing Collect on October 31, 2017, 12:50:26 PM »
Is your sliding scale billed monthly, or something you evaluate every 6 months? Yearly? I am confused how it can be considered a flat fee if it changes based on the # of patients.

I actually charge a flat fee based on my hourly rate plus expenses which includes a max # of claims and if the doctor goes over that amount, I charge a per claim fee. This is my first time billing this way so I am not sure how it is going to pan out but we'll see. I have no clue how many hours his account would require but after asking a few questions from Michelle's book, I did the best I could in estimating.
79
General Questions / Re: Incorrect Insurance Info-Who's responsibility?
« Last post by PMRNC on October 31, 2017, 11:23:27 AM »
If verification are not a part of your services, you don't do verification. However, what your describing is a claims denial or a rejection (clearinghouse level) and if claims follow-up and denials is a part of your service, it should be your responsibility to collect the correct information, even if not given to you at the time of initial submission. What you are describing really isn't a part of verification and eligibility but rather a follow-up/denial. It would also depend on your contract. My contract lists every single specific service I include for full practice management. I ALWAYS include verification/eligibility because then I know it's done right and how I want it which in turn keeps those rejections down.

To avoid this and any other services you might want to include but feel your not getting paid for, and you are doing a flat fee, why not base your flat fee on an hourly rate? For example if the client has you working an average of 30 hours a week on their account and you want $25 an hour, their flat fee would be $750 and then add expenses. A sliding scale to accommodate new patients (added work) could be based on an average of demographics/claims you can enter in an hour. If you can do 6 in an hour (demographics and claims) on an average, your sliding scale would be an additional $25 for every six new patients. Very easy. This is how I do it.
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General Questions / Re: Incorrect Insurance Info-Who's responsibility?
« Last post by Michele on October 31, 2017, 10:24:16 AM »
The doctors' offices enter insurance info (or sends it over on a superbill) for a patient. I submit the bill and it comes back denied as either incorrect carrier or patient has other insurance has primary. Just wondering how everyone handles it from there. Do you call the patient yourself for the correct info? Or reach out to the Drs. office to have them contact the patient directly?

We don't have huge issues with this, but if we get a clearinghouse rejection stating "coverage terminated" or something similar we try to find out what the issue is by utilizing insurance web sites first.  If we can find the correct insurance information then we update and resubmit.  If we can't then we notify the office first.  Sometimes they have the correct information in the office but it didn't get input correctly into the computer or onto the superbill.  If they don't have it we send out a statement to the patient advising them we need correct insurance information or they are responsible for the bill.


To add to that, I have a doctor who did not request verification services and he is paying a flat monthly fee. Unfortunately, I did not factor into his fee the time I would have to verify here and there for cases like this. Is it wrong to charge, in addition to the flat fee, for these times where insurance info was sent to me incorrectly and I am forced to verify the info that I have? Or refer it back to the office staff?

You can only charge for what you have in the contract.  You will need to add it to the contract and the provider would have to agree or notify the provider of the issue and have them implement something at their end to resolve the issue.
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