Author Topic: registering as third party biller for Medicare  (Read 2050 times)

kbailey

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registering as third party biller for Medicare
« on: October 30, 2008, 08:25:19 PM »
I've heard, can't remember where, that Medicare requires a separate registration for anyone doing billing as a third party - I'm in the state of Missouri who uses WPS - does anyone know if this is the case?  Also, any restrictions on how you charge Medicare?

Thanks!

Michele

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Re: registering as third party biller for Medicare
« Reply #1 on: October 31, 2008, 05:55:14 AM »
Most Medicare's (in most states) require registration to do electronic billing as a third party.  We do bill WPS, but not for Missouri.  We found their registration process to be fairly simple. 

I'm not sure what you mean on 'restrictions on how you charge Medicare?'  Do you mean what the provider charges for his/her services?  If so, there is of course the Medicare fee schedule.  I'm not sure what else you mean.

Michele
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kbailey

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Re: registering as third party biller for Medicare
« Reply #2 on: November 01, 2008, 10:24:12 PM »
Yea, even when I re-read it I wasn't sure what I'd meant (in my defense, it was a REALLY long day!)  Anyway - I meant for the State of Missouri, billing WPS, is there any restriction billing the provider a % in lieu of charging a flat fee?

Michele

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Re: registering as third party biller for Medicare
« Reply #3 on: November 02, 2008, 05:54:30 PM »
We actually just sat down with our lawyer last week to discuss the % being considered fee splitting.  In NY there is a law stating that you can't charge a percentage.  I'm not sure what the law is in Missouri.  I hope someone else on the forum can help us out.

Michele
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Michele

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Re: registering as third party biller for Medicare
« Reply #4 on: November 02, 2008, 06:07:34 PM »
I should have mentioned that there are ways around the fee splitting thing.  You can charge a flat fee but re-evaluate it often, or word your contract carefully (with the help of a lawyer) so that it is not fee splitting but is similar to charging a %. 

Michele
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Savings

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Re: registering as third party biller for Medicare
« Reply #5 on: February 14, 2009, 11:25:44 AM »
Michelle,

Do you know of any other states that are not allowing % billing?  (most of our clients are in Georgia)

Thanks,
David

Michele

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Re: registering as third party biller for Medicare
« Reply #6 on: February 14, 2009, 05:04:49 PM »
I am only sure of NY State.  Sorry, I don't know about Georgia.  :(

Maybe another forum member can help.

Michele
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marypete

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Re: registering as third party biller for Medicare
« Reply #7 on: February 16, 2009, 03:11:43 PM »
Illinois is another state that doesn't allow % billing.

PMRNC

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Re: registering as third party biller for Medicare
« Reply #8 on: March 03, 2009, 01:11:31 PM »
Just to clarify a few things..
It's not a good idea to "work around" fee-splitting arrangements.
The other thing to mention is NOT it's being illegal for billing companies..but rather for the physician. In NY , Illinois, Florida it is cut and dry that physicians MAY NOT enter into fee-splitting arrangements, however there are 4 more states this is being brought to light into.
If you are in one of the states that prohibit fee-splitting arrangements, your not "necessarily" doing anything illegal, however if challenged, your contract is NULL and void.
Our subscriber area has more information on this as well as legal case studies.

Linda Walker
PMRNC
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Linda Walker
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