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Billing Services

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Angie:
So Michele when you prepare a claim for a patient do you check with that facility first before you prepare it or do you just prepare it off of what the patient provides to you. Say you receive a superbill from a patient, would you just take the information off of that and convert it onto an actual claim form? Or would you contact the facility first? Can a billing service just prepare a claim form for a facility without the facility knowing they are doing so???

Michele:
We almost always contact the facility first.  The only time we don't is when the patient provides us with info and absolutely everything needed is present.  ALso, the patient will state that the facility provided them the info so that they could submit their own claim.  Many times the facility just doesn't know how to complete the UB04.  We NEVER contact the insurance carrier.  We are strictly working for the patient to put the information into the required format.  We also include all information received from the facility so that the insurance carrier can see that our codes match what the facility provided.  We are not trying to code so that the patient gets reimbursement, we are strictly transferring the data.  We have talked with many facilities who are usually very cooperative and grateful that we are helping the patient since they can't.  Also, we have had facilities refer people to us. 

Angie:
Thanks Michele. I will be referring clients to you if we run into any problems! I was just wondering if one could just prepare a claim with just an invoice that says "Prepaid days" and amount or "Extended days" and amounts for the wilderness program. It has no codes on it other than a diagnosis code that they received from records they received. They just put a code on the UB04 as :type of bill: 0132 which is hospital, outpatient and we are not a hospital we are a wilderness program and for the rev code they are using 0169 which we did not provide. Also this company is preparing 1500 forms from information that we provided to the parents and are signing them without our knowledge. I just didn't know if this was standard practice for a billing service to do so.

Michele:
The UB04 does not require a signature.  The CMS does (or at least the indicator that you have a signature on file!).  I would not use 0132 for the type of bill for a wilderness program.  There are appropriate type of bill codes that could be used.  Sorry you have had to deal with an unpleasant situation.  :(

Angie:
Thank you again for all of your help.
Do you know if the 0169 rev code "Other General Classification" under "Other Room and Board would be an appropriate rev code for the full wilderness program?

I think that the type of bill would be 0842 which is Special Facility, Other, 1st claim..... if we did have to provide a UB04 claim for the program. Do you agree that would be appropriate????
And if we had to provide a claim for just the therapy sessions 0832 which is Special Facility, Outpatient, 1st claim?

Do you think you could whip out a book on "wilderness program billing"! ;)
Thanks so much for all of your help with this, very much appreciated!

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