Author Topic: Where do I start?  (Read 2186 times)

athacher

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Where do I start?
« on: April 03, 2008, 03:58:39 PM »
I have just started doing the insurance billing at a youth residential treatment center.  We are out-of-network, in-patient, 10 month average program.  I have SO many questions.  First off, we accept youth from all over the world so I won't have specific states I bill to.  Second, this is a self pay program, we send claims as a courtesy to the parents but don't guarantee benefits, but I would like to get as few denials as possible, obviously.

So, which form should I use, I also have been told to use both the 1500 and the UB04?  I would like to use software, but I don't need a lot of the bells and whistles that I am seeing in a search.  Also, do we need an NPI # or is our taxID# sufficient? 

Do you also have any suggestions or hints on getting a preauth?  We only have 48 hours to get one, but there are so many unrealistic hoops we have to jump through and I have never been successful in getting a preauth #.  I always have to submit everything for a "retro review". 

Any guidance you can give me would be very much appreciated.  Thanks!!

Michele

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Re: Where do I start?
« Reply #1 on: April 04, 2008, 06:21:29 AM »
Hi,
  Wow!  Lots of questions!  I will try to answer them all.

First, if you are billing for the facility then you need to bill on UB04 forms.  The only time you would use the CMS form is if you are billing for a physician's professional services.

If you don't want all the bells and whistles I think you may be interested in using a fill and print software.  It is just as it sounds, you fill in the fields then print the claim. 

You do need an NPI number for the facility as well as your tax ID number.  Many insurerers will not pay claims to any facility/provider who does not have an NPI number.  The ones that still do, will be stopping soon.

As far as getting preauth, I would recommend calling as soon as possible and just being very persistant.  Ask them exactly what is required and then follow thru on it.  If they don't respond quickly, call back again.  Tell them you don't want to be doing a retro review and you want an answer!

I think that covers all your questions. 

Good luck
Michele
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athacher

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Re: Where do I start?
« Reply #2 on: April 07, 2008, 11:47:40 AM »
So helpful!! Thank you.  Do you have any suggestions on a good fill and print type software?  Maybe something that keeps a record of past claims.  I submit about 25-35 claims a month.  Nothing huge, but a bear to keep up with while trying to complete my other tasks as well.

How do I go about getting an NPI number?  Is there a fee associated?

Also, When I submit a claim with a supervising physician and/or therapist, do I need to include their license and tax ID numbers on the actual claim?

This is probably something that your book would help out with.  I have gotten so many "I don't know" responses, it's nice to have some "definite" advice!   :) 

Alice Scott

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Re: Where do I start?
« Reply #3 on: April 08, 2008, 12:00:46 PM »
Glad we can help.

Actually we found a pretty decent fill and print software that does store some data.  It seems pretty good for a simple fill and print.  You can find more info on it at http://www.solutions-medical-billing.com/fillandprintsoftware.html  Click on the box at the top left of the page.

NPI numbers are free.  You can do an online app at https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.npistart
We also offer a service of completing the NPI app for you for $29.95 if you cannot do it yourself.

Tax ID numbers are required on claims, but not license numbers.

Let me know how you make out on the fill and print software!

Thanks
Michele
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athacher

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Re: Where do I start?
« Reply #4 on: April 10, 2008, 11:35:22 AM »
I went to the link for the fill and print software.  Just for your info and whoever reads this post  ;).  It is only for th CMS 1500 form right now.  They are working on software for the UB04 but it isn't ready yet.  I found something at this site http://www.medicalformsoftware.com/UB-04.htm.  I'm going to order and see how it works.  I'll let you know.

As far as the NPI goes, I think I'll give it a whirl on my own.  If I get stuck, I'll have you rescue me!!  ;D

Again, thanks so much for your help.  I am soooo glad I found your site.  Thanks for all you do!!

April