General Category > New!

What is third-party medical billing?

(1/3) > >>

alicecarlosmbc:
???

Michele:
Third party medical billing:  a service provided by an outside company that is contracted to manage payments and claims for a medical facility

ace:
I need your help,  I have a client who just started her case management business and needs payable codes (CPT"S) and amount that medicare covers and pays. All help would be appreciated
@Michelle Thanks in advance  :)

RichardP:
1.  The healthcare provider is supposed to deliver the care that is required for the condition diagnosed, and then bill for that care provided.  A provider is not supposed to go looking for which procedures pay the most and then perform those on their patients.

2.  A provider must be trained in order to be licensed by their state and be able to bill their services to Medicare and commercial insurers.  That training will acquaint the provider with the CPT code sets that are relevant to their practice and where to find the CPT codes and payment amounts.  Something is wrong if your client does not already know this.

3.  There is no set payment amount that is standard across all of the United States.  For the simple reason that the cost of living varies, from one region of the United States to the next.  Therefore, you must look for Code payments that are set for whatever region of the U.S. your provider is working in.  Medicare subcontracts billing work to regional Medicare Administrative Contractos (MACs).  The individual MACS provide on their websites the CMS data that includes prices for that region.  Your Medicare billing will be submitted to your regional MAC, not to CMS.

https://www.codemap.com/content.cfm?id=2620
MACs for the United States

https://www.optum360coding.com/product/48232/
Optum CPT Coding  (do not contain the payment amounts that you will find at your individual MACS)

https://www.idmed.org/idaho/UploadedFiles/IMA%20book%20order%20form%202021.pdf
Coding Resources

https://www.amazon.com/Current-Procedural-Coding-Expert-Professional/dp/1622545532
More Coding Resources

ICD-10 Diagnosis Code database.
(Click on "Indexes" and "Rules" at the top left of the page that comes up.)
http://www.icd10data.com/ICD10CM/Codes

ace - you say your client "needs payable codes (CPT"S) and amount that medicare covers and pays".

That information is available in the links I provided above.  The only thing missing is what services your client will be billing for.  Hopefully she knows what those are.  Otherwise, the links I provided will do you no good.

And - just in case you don't know:  Diagnosis Codes are free.  CPT Codes (Procedure Codes) are owned by the AMA, and are not free, except for the odd code you can find on the Internet.  That is the reason for the price on the resource material.

ace:
Thanks Richard for your reply. It was really helpfull. Deeply appreciated. I do have an another question, I just found out that when credentialing a Home Health agency one needs to have a reserve fund in the bank to get a HHA registered with Medicare and Medicaid. Is there a specific amount that needs to be there or how does that work ?

Navigation

[0] Message Index

[#] Next page