General Category > General Questions

Third Party Billing Regulations by State

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tallmanusa:
What is the situation in Arizona?

Do they require registration?

PMRNC:
Like I said,I've spent many years researching.   we have many of the laws and exact statues in our members only at www.billerswebsite.com

tallmanusa:
Licensing requirements are important to us, we service well over 200 clients nationwide. We reached out to HBMA, studied the laws in various states, and here is what we found.

1. New Jersey requires registration/ certification, in very clear terms.

2. New York requires registration if you are billing to medicaid, I did not find any  such requirements for commercial insurances and medicare.

3. Arizona, requires no patient collection efforts, even patient statements to be sent by billers are limited. We service Arizona, just NEVER have any contact with the patients and don't send any statements.
We never receive any money for providers anyway, anywhere. That is a non issue.

4. Maryland, I am unclear for this state, I am still researching on this one.

My concern has been what the state laws require from us billers, whatever they require from the providers is not my concern, the providers should know what their state requires from them. Just like I follow the law applicable to us, they  should follow the law applicable to them.

If anyone has different information I would stand corrected.

PMRNC:

--- Quote ---
--- Quote ---My concern has been what the state laws require from us billers, whatever they require from the providers is not my concern, the providers should know what their state requires from them. Just like I follow the law applicable to us, they  should follow the law applicable to them.
--- End quote ---

--- End quote ---
In regards to operation of a medical billing company I agree to a point. I think that it would be irresponsible for any billing company to enter into any contract that would hurt a physicians license in any way. I see this as a marketing opportunity as well. On the flip side the billing company takes a chance of having their contract made null/void if they enter into one in a state where a physician is prohibited to do so. The recorded cases on record show the contracts as null/void on top of a physician being sanctioned. While it may be illegal for a physician, not the billing company, I think it's prudent for any billing company to look out for their clients, that is what we do!

 I think where the confusion came from was that the person asked about registration and in a later post you pointed out the fee-splitting. Which may have been where the confusion came in.  I'm not here to debate the laws. 
--- Quote ---There are three states, California, New York and Florida, which prohibit percentage fee for billing for medicaid. It should be noted that the prohibition is for the provider, not the biller; the provider has an arrangement with the medicaid, the biller does not.
--- End quote ---

I'd also like to point out that the HBMA was the one that back in 2000 decided to tell billers it was ok.. then later backtracked after a couple of years telling billers it was ok. 

tallmanusa:
Our contracts have the following standard clause.

CHOICE OF LAW AND FORUM. This Agreement shall be interpreted, construed, and enforced in all respects in accordance with the laws of the State of Massachusetts. The parties irrevocably agree that any action to enforce the provisions of this Agreement, or arising under or by reason of this Agreement, shall be brought solely in the Superior Court of Massachusetts, Middlesex County venue.

The choice of venue and law is standard for any contract. The contract cannot be voided without a court hearing where the venue was chosen by the parties under the laws of the state already chosen. That is the way legal contracts are drawn in United States.

There are fifty states, I don't know the laws applicable to someone else conduct in every state. And I am supposed to know the law in 50 states concerning the providers conduct, and the provider does not know the law in his own state where he has a license?

If he is such an idiot, I don't want to work with him.
He should know the law in his state that affect him, and act accordingly, if he does not, he is not our client.
Incidentally, we don't always accept everyone who wants us to do their billing.

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