Author Topic: Third Party Billing Application  (Read 1380 times)

AKA

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Third Party Billing Application
« on: October 10, 2018, 03:01:13 PM »
Help! I'm located in NJ and currently applying for a third party billing service with the state. I will start off as a sole proprietor and doing business at my home office. One of the documents needed is "a copy of the executed bylaws, operating agreement, rules and regulations, or other document relating to the operation of the applicant's internal affairs." Called the person who I will be sending this application to and asked if it's required for a sole proprietor and he said yes. So now, where can I get a sample of this for a sole proprietor? Most of the stuff I'm finding are for corporations and have several members.

PMRNC

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Re: Third Party Billing Application
« Reply #1 on: October 10, 2018, 10:57:52 PM »
I'm from NJ and familar with their registration process... let me first say that make sure every i is dotted and t is crossed because they WILL send it back and hold you up..they scrutinize every application! 

I'm a sole propietor but I'm an LLC for me i would send them my bylaws and P&P.
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other document relating to the operation of the applicant's internal affairs.
  For you as just sole propietor, not incoroporated or as LLC this would just be your operations manual or policies and procedures you do internally.

I have NJ PMRNC members who have told me they received 3 and 4 rejections for very small things. MAKE sure you send them EVERYTHING they require! Last time I saw the form they had 15 items on there. TAKE particular note to follow the law for the contract.. I think they provide you with the link for the provision. Also where it says to submit the means in which you will receive compensation..think twice about % if you plan to bill a % as they will reject it because of Medicaid law in NJ (fee-splitting provisions) I never reccomend a % anymore but if you are going to do it make sure your contract has a clause to provide compensation method for Medicaid. I've had billers get rejected for it. Cover yourself and have attorney review it for you first.

Another common rejection is that people submitting the application don't realize that what NJ calls a quality assurance procedures (or something similar) is actually your compliance plan.  And when they send you a rejection it's just check boxes and they don't give you details on what you were missing and in fact they will tell you they expect you to know..PAIN in the rear end...I don't have anymore NJ clients but in general it's a great way for billing companies to establish credibility in a very saturated market. NJ is full of billing companies who don't bother to register or don't know. When I get a NJ member, before I list them In our listing area, I make sure they are registered first.

Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

AKA

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Re: Third Party Billing Application
« Reply #2 on: October 11, 2018, 04:18:18 PM »
Wow thank you for this and for letting me know about the % part. I have it written on my business plan that compensation will be on a %. What do you suggest for me to put down for providers who take Medicaid? Also do you know how long it takes to get a response once I send my application?

Again, thank you for this. This is very informative! =)
« Last Edit: October 11, 2018, 04:21:04 PM by AKA »

PMRNC

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Re: Third Party Billing Application
« Reply #3 on: October 11, 2018, 04:30:12 PM »
I would work up either a flat fee for Medicaid or per claim/per service..but you want to make sure that is fully disclosed in your contract.

As for turn around I've heard 2 weeks is about average..but if it's a rejection they can hold you up another 30 days.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

AKA

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Re: Third Party Billing Application
« Reply #4 on: October 23, 2018, 12:13:11 PM »
Hi Linda,

Thank you again for the heads up with the third party application. I sent my application in yesterday and already got a response this morning! Like you said, they do look at EVERY single thing. I didn't put my middle name in one of the applications and I have to correct it. Grrrr. One of the things I was told that was missing was  in my standard contract it should include the responsibilities of the third party billing service to the provider with respect to maintenance of back-up systems against loss of records AND responsibilities of the third party billing service with the client with respect to maintenance of insurance coverage by the third party billing service against risk of loss. They also did state that the third party billing service does not have to provide any of these but the contract must make it clear whether or not the third party billing service is providing these items to its client. Are you familiar with this and what would you suggest I put on my contract? And would this be under the BAA? Do most medical billing services provide these to their clients?

PMRNC

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Re: Third Party Billing Application
« Reply #5 on: October 23, 2018, 02:02:35 PM »
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One of the things I was told that was missing was  in my standard contract it should include the responsibilities of the third party billing service to the provider with respect to maintenance of back-up systems against loss of records

This is something you will want to get directly from your compliance plan. Yes most providers want this info and it's one I learned early on which was when I realized a compliance plan was necessary before the contract. Most billing company's don't even have a compliance plan despite its importance. If there is ever any violation, your compliance plan can go a long way to reduce or eliminate fines/penalties and to show lack of "willfull neglect" under HIPAA and HITECH. With that said, information on your backup system will be in that compliance plan. YES absolutely clients want to know what happens if you were to be flooded, become ill, or god forbid worse, where is their data? This is especially important if you are licensing your own PM system to which a client isn't accessing. Some billing companies have the capability of having providers create and maintain your own backups. In my contract, the provider is responsible for any/alll backups because I do not license or utilize my own system, ALL clients data resides within their system/program and that is also in my compliance plan in two areas "disaster recovery" and "client responsibilities".

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AND responsibilities of the third party billing service with the client with respect to maintenance of insurance coverage by the third party billing service against risk of loss.

Yes this also would be in your compliance plan. If you have Errors and Omissions the carriers name, address, policy number and rep (if given one) should be there.  It is not required to have E/O, however it is strongly reccomended.  Whether you offer it or not it should be in your contract that you have it or you don't. This is one of reasons I like NJ Registration, because they are such sticklers your contract will be a good one to meet areas most other billing companies don't even address. For example, I can tell you most billers include a hold harmless clause because maybe their attorney said they should. In this business a hold harmless clause is completely useless and will be tossed out in court because as the billing company and business associate you are responsible for what you bill out. If you have  hold harmless clause IT COULD serve as substitute for the insurance info for the sake of the NJ registration but i would ask them first. I've had E/O from the beginning so it was always in my contract so I am not exactly sure NJ is saying here you must have it. I'm thinking you would either have to have it and mention it or not have it and assume liability, but again I would verify this with NJ first.

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They also did state that the third party billing service does not have to provide any of these but the contract must make it clear whether or not the third party billing service is providing these items to its client. Are you familiar with this and what would you suggest I put on my contract? And would this be under the BAA? Do most medical billing services provide these to their clients?

Right, you don't have to put those in your contract but like they said it has to be "addressed" so you want to consult with an attorney on how you should word that. A provider may see the hold harmless clause and no reference to or a reference to not carrying insurance and it will look unfavorable.

IF you have a compliance plan, those things mentioned will or should be in there. I always advise billing company owners to have that in place meeting all elements before their contract so that your contract reflects the items in your compliance plan and as I mentioned, NOT having one could be harmful to your business and your personal assets depending on how your business is structured.

The BAA is completely separate and apart and the client is responsible for making sure they have you sign one, but I always advise to have it ready in case they don't have you sign one. Under HITECH a BA is still REQUIRED to perform Risk Anlalysis, (Most billing companies don't even realize this is mandatory),  so you really need to be sure to take the lead on these things even if the client never brings them up. It's why a compliance plan is so important as it really is your road map to being and maintaining compliance not to mention to cover your !@* if needed.   Most E/O carriers require it also to obtain the proper insurance.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers
www.billerswebsite.com

AKA

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Re: Third Party Billing Application
« Reply #6 on: October 25, 2018, 11:22:39 AM »
Thank you so much Linda! You have been very helpful!  :)

Medical Billing Forum

Re: Third Party Billing Application
« Reply #6 on: October 25, 2018, 11:22:39 AM »