Special Forms?

[kittykat]

Hey Everybody!

I have worked a bit in insurance but have a friend who runs a substance abuse facility ask me if I could do their billing. The question I have is how will I know what they want me to bill. She mentioned calling me and letting me know but I feel like there should be some kind of form or something to use to communicate this back and forth. I am not certified to code so I know I cant do that so that would be on their end. Should I just make my own form that basically says something along the lines of

Name
Diagnosis code
Description
Rate
Length of Stay
Effective Date

Should I add anything else or take something off? I guess my question is what does everyone else do to communicate this information back and forth between biller and facility. We would be using fax to get this info to each other. Thanks in advance for any help you guys can give me! This forum has already been super helpful!

[PMRNC]

Oh my .. you definetely don't want to just use a phone call. Are you going to be working as an independent biller, employee, your own business? There are NUMEROUS things you need to do before you just "start billing".   You'll want proper agreements in place BAA, contract, etc. You will need either billing software or your own HIPAA compliant login to their billing system.

There are a lot of steps in between for you to do this. Be very careful of your own liability here.

[kittykat]

Yea I have software and clearinghouse. I also just finished my HIPAA reg manual. I have been going over this stuff for about 2 months getting everything lined out. I told her a phone call couldnt work either it needs to be a form or something. Something on paper. Would a form like that work? Or what is the industry standard I guess is what I am asking. Thanks again!

Oh they have also signed a contract with me and right now it will just be me billing but I created a LLC so it is a billing company.

[PMRNC]

You'll want the patient encounters and you'll also need all the Patient info sheets along with copy of front/back of insurance cards as well.

[Michele]

Name
Diagnosis code
Description
Rate
Length of Stay
Effective Date

This form is ok for inpatient rehab except you will also need to know the type of bed, private, semi-private, etc.  Look at the rev codes for Room & Board.  If they only have one type of room then you won't need it on each form, but you need to know what type of room it is.  Billing for inpatient rehab does not require a certified coder if they bill an all inclusive stay.  The only thing you will need is the rev code for room & board.  You will also want to have the auth number if there is one.  Usually inpatient rehab requires preauth.  Also will they be billing at the end of the stay for the entire stay, or will you be billing for segments of the stay as it goes along?  We usually bill for each week.   That way you aren't waiting 30 - 90 days to bill and then finding out there is a problem.

Also, you may know this but I would hate to not mention it if you don't, this is done on UB04 forms. 

[kittykat]

Thank you so much for all the help! I didn't even think about the type of bed. I am adding that in and going to make that form now. This forum has helped me a lot. Not even just this question but going back and reading all the other post. This seems like a great community and hopefully one day I will be good enough at doing this I'll be able to answer some others questions as well! 

[Michele]

   Glad to be able to help!

[kittykat]

I have one more quick question.

During the Utilization Review insurance will approve to cover a certain amount of days. So say they cover 7 days and I plan on billing weekly. Do I need to wait until those 7 days are up to send in a bill or could I do it on like day 5. Basically could I bill every Friday even if it is in the middle of the approved insurance days? I hope that makes sense haha

And I realized earlier that Michele is the writer of the books. I want to say thank you. I bought the UB04 book a while back and it was a huge help!

[Michele]

It really is up to you.  You could bill after just 5 days.  Personally if there were only 7 days I would probably wait and bill all 7 on one form.  But either way is ok.

Glad the book was a help!

[danibrittany64]

Usually in special form these terms are mentioned like

Name
Description
Rate
Diagnosis code
Length of Stay
Effective Date