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Patient Billing / Re: Patient Balance with COB
« Last post by Michele on July 22, 2021, 02:59:31 PM »
This is a tough one.  But since you are in network with the secondary, if they are saying there is no patient responsibility you would be violating the contract with them if you bill the patient, even if the primary says you can.
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Patient Billing / Patient Balance with COB
« Last post by Gayle33 on July 21, 2021, 06:52:57 PM »
Hello I'm looking for clarification on posting COB claims.  If we participate with both primary & secondary ins. is there still only 1 adjustment/write off?

Ex:  secondary does not pay the full patient balance from the primary, can we balance bill the patient for the remaining amount they would have paid ?
I've noticed some secondary plans do not pay the full patient balance and then apply an adjustment leaving no patient resp. If this is the case then we are getting less payment for a claim than if they only had the primary plan.  I've always thought we apply the primary adjustment and if the secondary does not pay the full patient balance then we bill the patient for the remaining balance with no additional write off.  Which is correct ?

Any input would be appreciated, Thank you.       
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Billing / Re: Psych testing by LPC
« Last post by Michele on July 20, 2021, 09:48:08 PM »
Wow, I'm surprised.  But if the rep isn't responding and can't show something in writing as to why it's not covered, then the insurance commissioner may be your best bet.

Does the LPC have a copy of the BCBS contract?  Maybe it addresses it in there.
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General Questions / Re: BCBS YLD/U9N PT
« Last post by Michele on July 20, 2021, 09:45:58 PM »
Do you have the accept assignment box checked no? 

Honestly the reps should be able to figure it out.  They can't just let them process as in network and not get to the bottom of the issue.  Are they at least reprocessing them as out of network?
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Billing / Re: Psych testing by LPC
« Last post by EBurleyStill on July 20, 2021, 03:04:04 PM »
Thank you for your reply.  Yes she is getting reimbursed by Tricare East & several of the Medicaid CMO's. 

That's why it is so strange that Blue Cross is saying that she is not contracted for that.  The provider rep has scheduled meetings with her to discuss the issue & keeps rescheduling.  She is considering taking the issue to the insurance commissioner...  :-\
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General Questions / BCBS YLD/U9N PT
« Last post by Laura1234 on July 20, 2021, 02:54:37 PM »
We're having some issues with claims being procesed In network when we are out of network.  I noticed it was only for polices with prefix YLD and U9N, and they take a long time (over 45 days) to process.

The reps do not seem to know what the issue is.  Any idea?

Thanks in advance
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Billing / Re: Psych testing by LPC
« Last post by Michele on July 20, 2021, 11:26:50 AM »
Is the LPC being reimbursed by other insurances for the psych testing?  We bill a lot of mental health, including psych testing.  I am not surprised that it is not covered when performed by an LPC. 
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Billing / Psych testing by LPC
« Last post by EBurleyStill on July 19, 2021, 01:07:20 AM »
I am billing for an LPC who does psych testing.  She's billing 96130 and 96131.  All of her BCBS claims have denied.  This was before we started billing for her.  Not positive on prior auth being obtained, but she bills within the normal unit limits.
After much communication with the provider reps, she was told that she was not contracted with Anthem for billing testing. 
Has anyone heard of this?  Does one have to specifically ask to bill certain codes? I have more experience with MDs & PHDs.  I know there are certain limits as to what can be billed by LPCs and must use proper modifiers but this puzzles me.
Thanks for any assistance!
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Starting Your Own Medical Billing Business / Re: Advice Needed!
« Last post by williamportor on July 15, 2021, 11:18:26 AM »
Congrats on your decision to start a medical billing business.

How did I start?  My wife started the business about 9 years ago, working for a Chiropractor, she taught me how to fill out a HCFA form, I took things over when she found a full time job, and began to build my client base. I now have 6 provider clients. 4 Chiropractors, 1 Ophthalmologist, 1 Psychiatrist.

The best advise I can give you is to read these forum posts, the bulk of what you need to know is here. This can be a great business, but Kristian is correct, it's tough signing up your first client, so please pay serious attention to the posts on marketing.

Best of luck   
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Starting Your Own Medical Billing Business / Re: Advice Needed!
« Last post by kristin on July 13, 2021, 10:04:46 PM »
As Michele said, there is a lot of information on this forum. Many others have asked a similar question to yours in the past, with a lot of advice being given.

While I don't own a billing company (although I had considered it in the last year, but decided against it), I have worked/do work for various billing companies.

Generally speaking, the hardest part when starting a billing company is getting your first client. From there, you want to retain that client, and hopefully through referrals, get more clients. You want to make sure you are charging the client legally within your/their state, and that what you are charging them actually accounts for all the work you do. This is why percentage billing is not the best route to go, usually.

If you plan on offering a full RCM service to your clients, realize this will take A LOT more time than you think it will. You say you are starting a new job...if it is a full time job that you plan on keeping for income after you get your first client, you will definitely need someone (your wife, in this case) to handle all the things that need to be done during regular business hours for clients....contacting insurance companies, taking patient phone calls about statements, etc.

You said you are taking a course right now, I am guessing it is some kind of course that ends up with you being a CMB, or something similar? While that is great, there are some downsides to those types of courses. They aren't always accurate in terms of what happens when you actually get into the "real world" of billing.

Finally, you said you are ready to grind and build your business into something successful. That is EXACTLY the attitude you need, if you want to be successful, and no, this isn't a get rich quick business. With most clients, you will break even or make a enough of a profit to live on. Case in point, I have been working for a particular billing company for about 8 years. We have 10 clients. 8 of them we break even on, or make a small profit. The other 2 are the moneymakers, and they are the reason we are able to keep the other 8 clients as clients.

Best of luck to you in your new venture!
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