Billing > Facility Billing

Quick question: Billing for residedntial rehab facility

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Michele:

--- Quote from: Beth on July 28, 2016, 11:16:33 PM ---Thanks for the help Michele. I know the question was stupid like the other person who replied basically said and I was assuming it could work either way but I just like having definite answers.

I had an old friend from college who was doing utilization review for a billing company and she wanted to go out on her own but needed a partner. She said this job was super easy and the money was good. I'm not doubting the money can be good but this is not a job you can just wake up and do. There is so much information. Turns out she knew nothing about the billing side so I'm basically statting from scratch if i stick with it. So thanks again. And thank you for writing the books as well. Your book on UB04 forms was super helpful!

--- End quote ---

No problem.  Your friend was definitely way off when she said it was "super easy".  There is nothing easy about this.  But you can make a decent living.

The only stupid question is the one that goes unasked.  ;)

kristin:
Beth, I would like to add one suggestion to this thread for you. Before you start working with your friend, get E&O insurance, if you haven't already. If your friend is starting a billing company, but doesn't know the billing side, and you are new to billing, you will need it.

Ypmb16:
If it is a commercial insurance plan, Bill per the auth. You will need to get the residential treatment authorized. So that will be authorized in a date range. So you bill that date range with the auth, on a UB04. Then the patient should drop level of care to PHP, then IOP Or OP. PHP, IOP, and OP all get billed on Ub's if billing a facility/hospital or a HCFA if billing for a LISAC or other professional. So it depends on how your billing and who your listing as your providers.

Learn your levels of care. Detox, RTC, PHP, and IOP will almost always require pre-auth which will require utilization review.

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