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Recovering Deny Medicaid Claims

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RCC:
Ok, so I need to have an experienced Biller to look over this account before agreeing on anything. Thanks for the information, I think I need to hire an experienced Biller to assist me and so me the ropes there is so much to know and I want to do this right and nit violate any laws. I was going to check with Medicaid also.

PMRNC:


--- Quote ---Ok, so I need to have an experienced Biller to look over this account before agreeing on anything. Thanks for the information, I think I need to hire an experienced Biller to assist me and so me the ropes there is so much to know and I want to do this right and nit violate any laws. I was going to check with Medicaid also.
--- End quote ---

Don't jump the gun.. for now you have not lost anything.. find out what you are dealing with first.. in as much detail as possible.. one step at a time. It could be a good acct to get your feet wet, just saying you need to protect yourself but at the same time be compensated for your time. The more you know about these accounts the better you can proceed.

Merry:
I would only call Medicaid of you have the approval of the doctor. Just your calling may open a can of worms.

You seem to be very through and asking good questions. It is difficult to know what you do not know which is why we are trying to help you through this.

Keep us updated please. And good luck

RCC:
Since I will be doing research to find out why the claims were denied, would you suggest I do a per claim charge and would $4 be sufficient?

PMRNC:
I personally don't like a per claim fee when I have not even decided what the problem is.. that's more consulting for now. What I do if a provider needs some research or even a practice analysis is have them sign the appropriate HIPAA Associates agreement. Then I sit down and figure out what they need, what reports I need. For your particular situation you want to see EOB's which will have what you need to get an idea of what's going on.. you will also want to run a full A/R and claims detail for all Medicaid. What I would do is charge an hourly consult fee, log your time, make sure you have at least a basic consulting contract signed along with your HIPAA Associates Agreement.. you could actually make this into a marketing thing where you offer a very reasonable hourly rate and discount and even a trial period. Then you get to see what your in for if you take the account further and they get the benefit of your experience/knowledge and you have an incentive to do right but also get paid for all time you put in. You don't want to do a per claim fee because your not sure what your submitting just now, you also won't have a billing contract so billing those claims should be OUT until you have a full contract for billing services in addition to all the necessary agreements in place.

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