Author Topic: Quick question: Billing for residedntial rehab facility  (Read 1429 times)

Beth

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Quick question: Billing for residedntial rehab facility
« on: July 28, 2016, 02:34:35 PM »
Let me start off by stating that I am absolutely new to medical billing. Long story how I got into this field but I'm really excited. I have a really stupid question though. I have been reading and researching for weeks but one answer I can not seem to find is when do you actually send the claim to the insurance company. With it being residential do I send it once they have finished their stay at the facility or can I send it before? I'm just a little confused. Would it be the same with an outpatient facility as well? If somebody could help me with this I would be super grateful!

PMRNC

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Re: Quick question: Billing for residedntial rehab facility
« Reply #1 on: July 28, 2016, 04:10:27 PM »
Beth, I mean NO disrespect..but you are in a situation where you SHOULD know the answer to this but your not. I'm being blunt I know.
 
Linda Walker
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Michele

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Re: Quick question: Billing for residedntial rehab facility
« Reply #2 on: July 28, 2016, 08:05:39 PM »
Let me start off by stating that I am absolutely new to medical billing. Long story how I got into this field but I'm really excited. I have a really stupid question though. I have been reading and researching for weeks but one answer I can not seem to find is when do you actually send the claim to the insurance company. With it being residential do I send it once they have finished their stay at the facility or can I send it before? I'm just a little confused. Would it be the same with an outpatient facility as well? If somebody could help me with this I would be super grateful!

Some residential facilities wait for the entire stay to be completed before they submit the claim.  Others like to bill as the stay progresses.  We billed for a residential facility that sent claims in weekly.  I recommend sending them weekly, especially if the facility is in network.  That way the AR is not tied up for so long and issues are resolved quicker.  If the facility is out of network and they are submitting as a courtesy to the patient then they usually wait until the stay is finished. 

For outpatient you would submit as services are performed. 
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Beth

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Re: Quick question: Billing for residedntial rehab facility
« Reply #3 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!

Sriram_Sub

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Re: Quick question: Billing for residedntial rehab facility
« Reply #4 on: July 29, 2016, 07:00:51 AM »
Wish you good luck, Beth!

Regards
Sriram
Sriram

Michele

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Re: Quick question: Billing for residedntial rehab facility
« Reply #5 on: July 29, 2016, 09:04:50 AM »
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!

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.  ;)
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kristin

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Re: Quick question: Billing for residedntial rehab facility
« Reply #6 on: July 30, 2016, 10:11:14 PM »
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

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Re: Quick question: Billing for residedntial rehab facility
« Reply #7 on: July 31, 2016, 09:43:51 AM »
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.