Starting a Medical Billing Business > Starting Your Own Medical Billing Business

registering as third party biller for Medicare

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kbailey:
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:
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

kbailey:
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:
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

Michele:
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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