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Billing Services

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Angie:
We only provide our families with a superbill when they request one to try to seek reimbursement from their insurance company because we do not participate with any of the insurance companies as they do not cover our type of facility. Sometimes when the client transfers to an aftercare program and it is denied the families will hire a company that specializes in denials which at that point that company will take all of their medical claims and try to help them. My question is it legal for that company to take our superbill and prepare it onto a UB04 or 1500 without our knowledge and submit it to the insurance company? And at times they will alter it and try to bill it under the facility instead of the provider we have on the superbill? I recently received a call from Blue Cross asking why we billed these services on a UB04 when they are for professional charges and why we billed it under the facility instead of the provider. I had told them that we did not do that and she proceeded to tell me also that someone is calling Blue Cross trying to get us set up as a out of network facility instead of out of network individual providers which we did not do. She gave me the name of the person that called so I know the company that is doing this and they are in no way affiliated with our company or contracted with us at all......Is this legal to do does anyone know???? Don't they have to have some kind of contract with us to do this????? She said it sounds like they are trying to represent our company.

Michele:
Wow, haven't heard of that before!  I know when you have a facility that does not accept insurance that it is common for the patient to try to get reimbursement for services. 

As for if it is illegal, I don't know but it certainly sounds unethical!  Did you ask BCBS if there was anything you could do since this person was not affiliated with you?

Angie:
I asked her if they could do that when they are not even affiliated with us and she said that it didn't seem like it and was very taken back by it but she was going to report it to the fraud and investigation dept to have it checked out. This company will also email me and ask me to forward all therapy notes along with the full medical chart like I am an employee of theirs without any kind of release from the parents. I don't do anything or even respond to them until I send the parents a release form but does she always have to have the personal therapy notes unless the insurance is requesting that directly? Do you know? She emailed me at one point and told me that it is the law that we provide the personal therapy notes when they are requested by anyone if there is a release on file. It just seems like it is a lot of personal information she is sending to the insurance when they are not going to cover our type of facility for one and she knows that and they are not requesting them, she is just sending them in with her claim she has prepared from our superbill when the parents have not even submitted it yet and received a denial or any type of payment.
We try to do everything we can to help the families seek some reimbursement as a courtesy because the insurance will not cover the facility itself so we don't accept insurance and we do not get into the whole appeals because the insurance simply will not cover our type of facility but they will reimburse their members for a portion of the therapy sessions that are provided directly by the therapist so it just seems REALLY unethical that she just takes the superbill that I provide to the parents as a courtesy for them to submit with a detail of how to submit it and then she just transfers it onto an actual claim form and charges the parents out the ying yang for it......just seems really shady!

Michele:
It does sound very strange.  We have done work like this ourselves and we don't request the therapy notes.  Unless she is some kind of certified coder who is going thru the notes to bill for each service independently, I can't figure why she wants them.  Also, maybe to attach to the claim because she feels that it helps with getting reimbursement??  Not sure.  I would continue to do as you are:  No response without a signed release, send info if you have a release.  Unfortunately the way she goes about her business alienates people and makes them not want to cooperate with her.  I come from a completely different angle and usually the facilities are very cooperative.  I am strictly trying to help the patient get reimbursement for what they are entitled to and bill exactly what services were provided.

I'm curious how she gets paid??  Possibly a percentage of what she gets collected?? 

Angie:
I am not sure how she gets paid for her "Services"! And you are right, she does go about it the wrong way. It is good to know that there are people out there like yourself and your business! Your books and this forum have been the most helpful to me. I have purchased so many books and attended a few webinars that really are of no use! Your books are so informative and so easy to read and understand and "who takes the time to provide a forum like this", I have never found anything like it! It is the best thing I have come across and I will continue to refer your services and books to everyone I know!
Thanks again Michele

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