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Insurance Payments / Re: Behavioral Health Reimbursement data
« Last post by Nick D on Today at 10:05:53 AM »
Hello,

Our office has multiple Residential, Partial Hospitalization and Intensive Outpatient facilities that we bill (out of network) for and we are considering developing a tool to help us decide if a plan reimburses fairly or if we should make supplemental payment arrangements with the patient or family. Prior to creating something ourselves I wanted to check with everyone here and see if anyone knows of a software or database that can help us estimate the reimbursements for our services.  If no one knows of something already existing I would be interested in starting talks with other providers or billing organizations that specialize in the above levels of care for mental health and substance abuse so that we could share data and maybe create a screening tool that would let the user know when a plan will be a dud or offer great reimbursement.

I too manage the billing for the mentioned facility types and levels of care. Although this sounds appealing, I think it would be detrimental to quality 3rd party companies that already have this information. I haven't yet heard of a centralized database to house reimbursement information and especially not by state. I doubt the payors would allow this for very long either. I do know that some billing companies offer an app to their clients which has historic payment information by level of care/policy. Always limited to their own histories though which is subject to a lot of variables (i.e. how they construct their ub04 claims; repricing; etc)

Message me directly if you wish to speak further!
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Insurance Payments / Re: Hearing aid repair payments by insurance s
« Last post by Michele on October 24, 2020, 01:23:55 PM »
Whether you can bill the patient will depend on whether or not you are in network with the insurance carrier.  If you are it is most likely against your contract to bill the patient.  You will have to look at the EOB/ERA to see if they indicate that you can bill the patient for the difference.
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Insurance Payments / Re: Behavioral Health Reimbursement data
« Last post by Michele on October 24, 2020, 01:21:34 PM »
I have not heard of a software to track that information.  It will be interesting to see if anyone else has.
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Insurance Payments / Hearing aid repair payments by insurance s
« Last post by CherylJude on October 24, 2020, 12:25:18 PM »
I work for an audiology group that in the past has billed the patient for hearing aid repairs. With insurances now getting in the hear aid game I have found that - BCBS for instance- will only pay $102.00 for a hearing aid repair but my cost is $160.00. IF the hearing aid is over 5 years old that cost to me is over $200.00. Since the patient has coverage and I have to bill that coverage how do I cover my costs? Can I bill the patient the difference? What might my options be?

Thank you so much for any insight into this.

Cheryl
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Insurance Payments / Behavioral Health Reimbursement data
« Last post by Tschoser on October 23, 2020, 06:32:30 PM »
Hello,

Our office has multiple Residential, Partial Hospitalization and Intensive Outpatient facilities that we bill (out of network) for and we are considering developing a tool to help us decide if a plan reimburses fairly or if we should make supplemental payment arrangements with the patient or family. Prior to creating something ourselves I wanted to check with everyone here and see if anyone knows of a software or database that can help us estimate the reimbursements for our services.  If no one knows of something already existing I would be interested in starting talks with other providers or billing organizations that specialize in the above levels of care for mental health and substance abuse so that we could share data and maybe create a screening tool that would let the user know when a plan will be a dud or offer great reimbursement.
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Starting Your Own Medical Billing Business / Re: Aetna / Electronic Payments
« Last post by Michele on October 22, 2020, 07:20:50 PM »
You have to sign up for Aetna ERAs.  Check with your clearinghouse.  Ours suggests using Enroll Hub.  But I believe you can also use Availity.
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Billing / Re: 99072
« Last post by Michele on October 22, 2020, 07:19:25 PM »
We have not billed that code out for any providers yet.  But I believe you would need to charge the same to a self pay patient as you would to a patient with insurance.
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Starting Your Own Medical Billing Business / Aetna / Electronic Payments
« Last post by williamportor on October 21, 2020, 04:59:35 PM »
Hello-

I recently submitted several claims to Noridian Medicare, some of which were forwarded to Aetna who now seems to be paying some claims electronically. My provider client sent me a number of paper notices of electronic payments, with no patient names, dates of service or other EOB information. A 45 min. call to Aetna's provider services line (and it's beloved automated phone system) proved fruitless. The electronic payer services phone number it gave @ 888-247-1203 did not answer. The Aetna phone system would not allow me to speak with a live human. Calls to the Aetna corporate office were a no go...the operator said I had to call provider services (again!) All I want is the EOB information for these payments so I can post them. I'm used to this Insurance Co. run around by now, but this one is a dead end. Can anyone tell me where to go for the EOB information??   
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Billing / Re: 99072
« Last post by rdmoore2003 on October 21, 2020, 12:45:49 PM »
yes, I meant 99072
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Billing / Re: 99702
« Last post by Michele on October 21, 2020, 12:01:27 PM »
Do you mean 99072?
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