Author Topic: NY based billing company billing for NJ Provider?  (Read 11861 times)

kosterweil

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NY based billing company billing for NJ Provider?
« on: December 07, 2012, 11:13:18 AM »
Can a NJ provider outsource billing to a NY based company who is not registered with the state of NJ?

thanks!!!

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #1 on: December 07, 2012, 11:17:50 AM »
Third Party Billing Company Registration with the state of NJ is required for those billing companies LOCATED and DOING business in NJ.
Linda Walker
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PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #2 on: December 07, 2012, 12:31:51 PM »
You said the provider was in NJ, and your billing company in NY you need to register with the state of NJ, because you will be doing business in NJ.
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RichardP

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Re: NY based billing company billing for NJ Provider?
« Reply #3 on: December 10, 2012, 02:03:43 PM »
I'm not trying to be anal here, just helpful to the next person who reads this and is confused.  Linda - for those of us who think words mean what they say, can you clarify this discrepancy please.  Your answers contradict each other.  In mathematical and computer logic, the word AND means both statements must be true in order for the condition to hold.  In this case, both statements are not true (kosterweil is not both located in AND doing business in NJ).  Perhaps you meant to use the word OR instead of AND.  That way, the condition holds if either of the statements are true.  The way the words are structured below, only one of your answers can possibly be true - unless you meant or instead of and.

... registration [is required] for those billing companies LOCATED [in] and DOING business in NJ.

versus

... you need to register with the state of NJ, because you will be doing business in NJ [even tho the billing company is not located in NJ].
« Last Edit: December 10, 2012, 02:07:06 PM by RichardP »

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #4 on: December 10, 2012, 04:43:35 PM »
... registration [is required] for those billing companies LOCATED [in] and DOING business in NJ.

Yeah should be the word "OR" . if you are a billing company IN NJ or anywhere else and doing business IN NJ you must register as a third party billing company in the state of NJ.   

Linda Walker
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galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #5 on: January 23, 2013, 08:15:21 PM »
I am still confused by this. My office is located in Tampa, Fl. I have clients all over the country. So you're saying, I have to register my business all over united states? I currently have 14 accounts and they are all over the country. As per my attorney and accountant, it's where you are physically located and where your bank account was opened. It's where you are at, not where your clients are.

RichardP

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Re: NY based billing company billing for NJ Provider?
« Reply #6 on: January 24, 2013, 01:28:35 AM »
States have a right and responsibility to regulate commerce within their borders - and they do.  Where you and your bank account are located are irrelevant to the central issue here.  If you do business within a state, that state has the right to regulate you.  States won't all regulate you in the same way, and some may not regulate you at all.  But all have the right and responsibility to regulate the commerce within their borders.

Now - where did you say your client was (rhetorical questions)?  In what state is the business conducted that you do the billing for?  In what state does your client earn his money?  In what state does your client pay his taxes on monies earned?  In what state does he write the check to pay you for your services?  You are conducting commerce in that state, whichever  one it is.  Therefore, the state has a right and responsibility to regulate the commerce you conduct, and how you conduct it, in that state.  Some states may choose to not regulate you.  But other states do choose to regulate you.

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #7 on: January 24, 2013, 08:51:29 AM »
Quote
I am still confused by this. My office is located in Tampa, Fl. I have clients all over the country. So you're saying, I have to register my business all over united states? I currently have 14 accounts and they are all over the country. As per my attorney and accountant, it's where you are physically located and where your bank account was opened. It's where you are at, not where your clients are.

If you work accounts in any state that requires registration, licensing, etc.. Yes you need to adhere to their rules if doing business in one of those states. Likewise since you are in Florida, it's one of the states that prohibit's physicians from entering into any fee-splitting arrangement (% based billing) however if you have a client in another state that does NOT, your provider in that state can enter into that contract. Provider's in the states that prohibit fee-splitting arrangements would not be able to enter into those types of contacts.   

Remember also that dealing with multiple states does indeed knowing the regs and rules in each state. We all know Auto/No Fault, Workers Compensation and Medicaid and even BCBS have state by state rules to follow.   Knowing the regs of the state in which you are billing or doing work in, is certainly a must.
Linda Walker
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galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #8 on: January 24, 2013, 09:40:39 AM »
 I don't think I was understood properly. I wasen't asking about fee splitting, registrations, etc. I have an S corp in Florida. So you're saying if I have accounts all over the country, I need to have an S corp in every state. I am not talking about regulations and how to do business there.

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #9 on: January 24, 2013, 10:36:24 AM »
The fee-splitting was just an example.

Quote
I am still confused by this. My office is located in Tampa, Fl. I have clients all over the country. So you're saying, I have to register my business all over united states? I currently have 14 accounts and they are all over the country. As per my attorney and accountant, it's where you are physically located and where your bank account was opened. It's where you are at, not where your clients are.

When you said "registration" I was assuming since we were talking about a diff type of registration as in the original message of this thread that is what you meant. This was never about tax/business "structure".  SOME states require registration of third party billing companies that do business in their state, such as in the case of the original message (NJ).   
Linda Walker
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RichardP

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Re: NY based billing company billing for NJ Provider?
« Reply #10 on: January 24, 2013, 11:04:05 AM »
So you're saying if I have accounts all over the country, I need to have an S corp in every state.

As I stated above, the larger issue here is that states have the right to regulate commerce in their states.  If you are going to conduct business in any given state, it is up to you to find out what those regulations are.  That is the legal answer.  The pragmatic answer is that, doing the billing for a doctor or two in a given state is not likely to attract the attention of that state's regulators - so you could get away with doing nothing.  The problem is, if you somehow screw up someone's billing and you get sued by the patient or the doctor, that suit will be governed by the laws of the state that the doctor(s) or patient(s) resides in.  You probably don't want to find out in the middle of a law suit that certain regulations you didn't know about actually do apply to you and you have been ignoring them.  In the long run, it is to your benefit to contract with a local business attorney who can find out what, if any, regulations affect you in the states where you are conducting commerce.  Think of it as insurance.
« Last Edit: January 24, 2013, 11:06:45 AM by RichardP »

galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #11 on: January 24, 2013, 01:46:14 PM »
Got it. Yeah, I am not a coder but a biller. I bill what the doctor writes down. At the end of the day, the doctor is responsible for his billing not me. My job is to submit what the doctor bills and to make sure it gets collected. Honestly, I've been in this business for a while now and I haven't heard billing companies getting sued unless they were dong fraud or adding things to get paid more. In this business from my experience, you do what you are supposed to do, collect what you can and that's it. Its very simple.
Thanks for clarifying that.

PMRNC

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Re: NY based billing company billing for NJ Provider?
« Reply #12 on: January 24, 2013, 02:38:51 PM »
Quote
Got it. Yeah, I am not a coder but a biller. I bill what the doctor writes down. At the end of the day, the doctor is responsible for his billing not me. My job is to submit what the doctor bills and to make sure it gets collected. Honestly, I've been in this business for a while now and I haven't heard billing companies getting sued unless they were dong fraud or adding things to get paid more. In this business from my experience, you do what you are supposed to do, collect what you can and that's it. Its very simple.
Thanks for clarifying that.

Not sure what coding has to do with any of this.. but I have to say I completely DISAGREE with your assessment that you just "bill what your given"  Along with Fraud comes Abuse, there's a difference. Also the law gives NO lead way for "ignorance"  If you are given a code to bill and YOU are supposed to know what your billing and you don't, that's a no no.   I'm not trying to take away your experience in this business, however I feel saying what you said is irresponsible. I have seen MANY billers and even office managers/billers in house get sued INDEPENDENTLY because they are JUST as libel.    With fraud and abuse guidelines there is NO excuse for ignorance.   A biller "SHOULD" know. it's THAT simple.    Again, not trying to take anything away from you, but I don't think it does justice to those getting into this business to think it's simple data entry and your off the hook. It does not work that way at all.    That is why it's imperative to have E/O insurance.
Linda Walker
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One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

RichardP

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Re: NY based billing company billing for NJ Provider?
« Reply #13 on: January 24, 2013, 02:52:06 PM »
We never just bill what we are given.  We are constantly giving work back to our clients for a re-code when we see where the client could legally code differently to get paid more, or where he did work but failed to code for it (the old, I see that you did A; I know that if you do A you also have to do B, but I don't see any codes for B listed on the fee slip).

galinafl26

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Re: NY based billing company billing for NJ Provider?
« Reply #14 on: January 24, 2013, 03:00:00 PM »
With all due respect, I've been in this business probably a bit longer than most people here. Not only have I've been in this business longer, I have an MPH in healthcare administration as well so as far as laws are concerned, I think I know them better than anyone on this forum. Having said that and clarifying that, I am not saying that a biller's job is simply data entry however, at the end of the day, its the doctor who is responsible for their billing! It's the doctor that has to know what is going on in their practice! At the end of the day, its the doctors responsibility to CHECK what the biller is billing, what codes she or he is using, what is collected, etc. The point I was trying to make here is that its still the doctors responsibility to know what is going on in their practice. Yes if you are given a code you should know what that code means however its the doctors responsibility to know the codes, not the billers! As much as you don't want to think of yourself as only a data entry person, you are DOING DATA entry. You are entering the information the DOCTOR gave you to bill. Maybe  you don't want to look at it this way but hey we all doing data entry. To collect, is a different story, yes I agree,  it's much more complicated that than, but as far as entering the information from a super bill is called DATA ENTRY. I don't agree with you on a lot of things you say on this forum and the advice you give to people that are just starting, but everyone is entitled to their own opinion. This is just mine.