Author Topic: Start Up Question  (Read 1405 times)

RobertJ

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Start Up Question
« on: January 30, 2013, 11:21:13 AM »
Hello Everyone!

I got to this website while I was googling a medical billing question. When I went though it, it has a wealth information that any billing person can imagine. Just amazing.
I have a question. I am trying to start my own billing company with my friend. We both have 7 years of experience working for physicians. I would want to know if we should get our business enrolled with Medicare, Medicaid and other commercials before we do any billing for any physicians. My understanding is that, billing companies work for physicians as a business associate. They do their billing under the physician's names, so, a separate registration is not necessary for a billing company. Please clarify this. Any inputs from you is greatly appreciated.

Thank you,
Robert.

RichardP

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Re: Start Up Question
« Reply #1 on: January 30, 2013, 12:01:19 PM »
We are in California, and we are not required to register ourselves with the insurance carriers, including Medicare and Medicaid.  Our doctor clients are required to give certain information about themselves when they apply to become affiliated with a given insurance carrier.  The doctors, not us, would be responsible for giving appropriate information - including details about us, if details are requested.

If we were to submit electronic billing directly to the insurance carrier, or to Medicare (which anybody who wants to bother with it can do, if the carrier accepts direct electronic billing), we would need to register with them and provide whatever information they needed - independent of what information the doctor would have to provide in order to be a participating provider.

This is not a legal opinion, but I think that a billing company that submits billing electronically directly to the insurance carrier moves from being a business associate to being a covered entity, as both terms are defined in the HIPAA and ACA regulations.  I don't know that you will get two different health-care attorneys to agree on whether I'm correct or not, given that this is new legal territory that is being plowed up and it will take awhile for case law to build up so that lawers are in agreement over the definition of terms.
« Last Edit: January 30, 2013, 12:07:41 PM by RichardP »

PMRNC

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Re: Start Up Question
« Reply #2 on: January 30, 2013, 12:15:09 PM »
Medicare providers are required to report a change or addition to a billing agent on their 855 enrollments.    Also check your own individual state requirements as some states do require registration/certification with Medicaid such as NY.    Other states may require a registration just as a third party billing company such as the state of NJ.   You want to check your govt payors for each state in which you will work in and do business in.    Commercial carriers don't require any special registration from the billing company.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
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RobertJ

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Re: Start Up Question
« Reply #3 on: February 01, 2013, 09:54:25 PM »
 :)Thank you so much.