UB04 Instructions Now Available

Michele and I have been working hard to make the December 1 deadline for our new book "UB04 Forms - How To Complete A UB04 Form Completely and Correctly, Line By Line, Box By Box." Hooray!! It's finished.

This book is now available for a discounted price of $29. until Monday December 3, 2007.

Billing C-Leg repairs

We received a question from Marilynne this week asking about billing for C-Leg repairs. We haven't had any experience with this yet and Michele wasn't able to locate any information on it so we're asking for help for Marilynne. Here's her question -

I have a question in regards to C-Leg repairs …..payment from Medicare…..how are other DME providers submitting there claims and getting paid….I hope you have some insite on this matter. Happy Thanksgiving..Thank you Marilynne

If you can help, please respond to this post and we'll let Marilynne know.


Thanks,
Alice

January 23, 2008
Be sure to check out the comment on C-Leg repairs - Thanks Jane

CAQH Credentialing

Are you familiar with CAQH and the CAQH credentialing process? Many of us are hearing more and more about it lately. Insurance companies are asking if you are credentialed through CAQH. What is it and why would you use it?

CAQH is a non profit organization which has come up with a universal credentialing system for providers of medical services. Once you complete a CAQH application, insurance companies can access that information online.

The largest benefit of this is that it will reduce the number of applications you must complete to become participating with insurance companies. The CAQH application is quite involved to complete, but well worth the problems. Here's more information about CAQH on our website.

UB04 Billing for facilities

We got an email from someone today that shows there is a lot of questions yet on billing for clinics. The lady was trying to get reimbursed for services she paid for on her daughter for drug rehabilitation. The claims were denied because they were not filed on UB04 forms. The facility told her that they bill only on CMS 1500 forms.

If the clinic is credentialed as a facility then the billing must be done on the UB04 forms. I think because they are unfamiliar to most offices, the clinics just do not want to have to learn to use them. But unfortunately, they are loosing money by not filing on the correct forms. They are a little more complicated than the CMS forms, but unfortunately they are necessary for payment.

We've just added a page to our website on facility billing. If you have any more questions on billing on UB04 forms, visit our facility billing page.

UB04 instructions available Dec 1

We are now completing our book "How to Complete a UB04 Form Correctly and Completely - Line By Line, Box By Box". It will be available as an e-book in PDF format for immediate download December 1, 2007. The cost of this book will be $39.95, but we are offering a special discount price to our readers of $29.00 if you place your order before the December release. Just place your order now. We will send you an email when it is available for download. You'll pay for it when you download it.

This book will be available in soft cover also from Amazon.com. Due to the technical issues of publishing, it should be available by the middle of December.

Also, three of our other books are now available through Amazon.com in soft cover. They are:

"How To Start Your Own Successful Medical Billing Business"
"12 Marketing Strategies to Grow Your Medical Billing Business"
"How To Complete a CMS 1500 Completely and Correctly - Line By Line, Box By Box"

These three books are also available as ebooks in pdf format for immediate download from our website.

Billing Codes Separately

We recently had someone ask us on our "Ask the Biller" page about billing for a Nebulizer treatment. The question was when you bill for a Nebulizer treatment do the drugs get bundled in or should you bill separately for them. If you would like to read Michele's answer to the question, click on the "Ask the Biller" link and look for the October 16 entry. Michele also has an interesting article on bundling at her blog.

My point is that a million questions come up like this in every billing office. If you haven't had a lot of experience with medical billing, this can be a problem. It can be difficult to know the correct answer or where to look for it.

That is the point of this blog and our Ask the Biller page. We truly enjoy helping others who have medical billing questions. So if you've got one, ask away. We'll do our best to get an answer for you.

Setting Up A Mailroom

When you submit medical insurance claims to insurance carriers, even if you are sending them electronically, you will still have lots of claims to mail. Many claims are still not accepted electronically and many companies don't have the capability of accepting secondary claims electronically.

We quickly found that we had to work out a system for getting these claims in the mail efficiently. We developed a great system for sorting, stuffing and mailing these claims.

We start with two corrugated boxes we found at an office supply store divided into 30 sections each. They are also available in wood and steel and are called literature organizers. I labeled about ten of them with the most common insurance companies we deal with. I then started with A and went to Z using either one or two letters per compartment. As insurance claims are printed and ready to mail, they are sorted into the correct compartment for that particular insurance company. Excellus has it's own slot for all the insurance claims we submit to the local Excellus. We get a few claims that must be sent to Excellus in Florida or Mississippi, etc. Those out of state claims are placed in the E slot.

The claims are now presorted. When we are ready to mail them, we take the A's first and look through them to make sure no Aetnas or American Progressive (which have slots of their own) were placed in this bin in error. The A's are sorted, folded, and placed in window envelopes with our return address imprinted. We can place up to 14 forms in a business size envelope without going over the weight restriction for this size. I fold one form for the front window and then fold the others together behind the front one. If you fold them all together, it pushes the address lower in the window and sometimes doesn't fit the window properly. These must be folded as tight as possible as there is a thickness allowance for this size envelope.

When we have over 14 claims to one address, they are not folded and go into a large window envelope made for HCFA's. The postage rate for this size envelope is higher than for a small envelope so we use the small ones when possible.

When all claims are in their envelopes, we weigh them and add the proper postage. I do not use a postage meter machine as it is an added expense and not necessary. We are a small office that does not have a problem with stamps disappearing so we purchase a variety of stamps. I have a chart that I update with each postage increase to indicate exactly which stamps to apply to each envelope weight.

If you mail a lot of claims the post office has free information they will give you regarding the limitations on the size of the envelopes you can use and a slotted cardboard your smaller envelopes must fit through. It's much better to know all their new rules and avoid getting your mail returned and claims delayed.

Billing Medical Claims Electronically

We have finally reached the stage where most offices are billing at least some of their medical claims electronically. But the more important question is, are they reading their electronic reports?

Just sending the claims in electronically is not enough. If you are not reading the electronic reports, then you are losing money. It is crucial to your practice that these reports are being read and being read regularly. If you say you don't have time to be checking the reports, then I say that you don't have time NOT to check the reports.

The first report that comes back when you submit the claims electronically lets you know if the batch made it to the clearing house. This is pretty important because you don't want to loose a whole batch of claims that will affect your cash flow. Interruptions in the phone lines or lots of other things can cause a whole batch to get kicked out.

Another report will tell you if the insurance company is accepting the batch. This report will let you know if any individual claims have errors causing them to not be submitted. An example of this is when a claim is dropped for an incorrect ID# or no longer a member with that insurance carrier.

Their are many advantages to billing electronically at this stage. If you are a provider who is seeing the patient regularly, such as a chiropractor or a psychologist, you find out much sooner than you would by filing on paper that a patient's coverage has changed. You can ask the patient on the next visit if the insurance information has changed - before you've billed them for six visits and they all were denied.

If you are a billing service and must keep track of many providers electronic reports, it is crucial to keep an electronics log. Next month we'll explain how we set up our electronics logs for 50 providers.

Copyright 2007- Alice Scott

Sunday Afternoon

Hi again,
What a week. Sometimes we end up on the medical end instead of the medical billing end. Being a very healthy person who goes to the doctor very seldom, I really dislike medical emergencies. I took a long weekend off last weekend and visited my sister in Florida. It was a good trip but when I got home Tuesday night and called my 90 year old mom, she didn't sound right. To make a long story short, what looked like she had suffered her first stroke turned out to be dehydration from a viral infection. After a brief stay in the hospital, she's back taking care of her house and cat again.

So I'll get right back to my medical billing jobs again. Sorry for a couple "Ask the Biller" questions I didn't get to answer right away. I'll get to work on the newsletter again, too. Should be getting the newsletter out later this week. I'll be writing about billing claims electronically, setting up a mailroom, news on our books, and more. If you would like to sign up for our free monthly newsletter, you can sign up by on our website.

Thanks for reading.
Alice