Alice's Corner

Some Accounts Are Not Worth Taking

2008-12-14T07:11:00.006-05:00

When you are first starting your medical billing business, it is difficult to imagine but unfortunately it is true. Some accounts are just not worth taking. When starting out most billers wait with great anticipation for that first account. There is great excitement when that account is found and the contract is signed. We rejoice and celebrate. It may take a couple months for the stark reality to set in or you may start to see that it's not working as expected right from the start.

You may find that as you start your first account you just are not getting all the required information when you need it. Maybe the office was supposed to have the claims ready for your first pick up last week and you still haven't seen them yet. Sometimes you get a packet of claims with 25% of them missing ID#s, dates of birth, or diagnosis.

You may expect a large packet of billing and set aside a certain amount of time to complete that work to find that nothing is sent or a very small packet. Sometimes provider offices neglect to send you the eobs on time and you make needless claim status inquiries.

When we first started our billing services, we took on a couple small accounts that amounted to so little that it certainly was not worth the trouble. At that time it was still beneficial to us as it gave us needed experience in submitting these claims and practice with our software. We set up systems that we would develop as the years went by. The important thing to recognize is that when you get to a point where these accounts are not worth the work that they cause you, it is time to give them up.

Other accounts are not worth the work they present right from the beginning. They may never seem to be able to get everything together to send to you or they make unusual requests and demands that create an extra work load for you. You need to learn to recognize these and see them for what they are. Work with any office before you give them up. See if improvements can't be made to make the situation work for both of you. Check out Solutions Medical Billing for more information on dealing with providers.

Medical Billing in a Box

2008-10-15T07:27:00.002-04:00

We have released our newest package for medical billing services just starting out. It contains 5 books, 5 special reports, 50 blank CMS 1500 forms, our completed package of CMS 1500 forms for mental health billing, workbook, and for a limited time we are offering a free 15 minute consultation with either Michele or myself. The five special reports are not available elsewhere. We wrote them special for this package.

The five special reports are:

"Insurance Denials - Learn How the Pros Handle Them to Get Your Claims Paid"
"The Secrets of Authorizations and Referrals, What You Need to Know to Prevent Denials"
"How Participation With Insurance Carriers Affects Your Billing Business"
"How to Choose the Best Practice Management System for Your Business"
"Learn the most effective marketing technique we’ve ever used"

The books 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 (HCFA 1500) Completely and Correctly - Line By Line Box By Box"
"Secrets to Signing Up Your First Doctor"
"Basics of Medical Billing"

For more information on this brand new package visit Medical Billing Live

Training New Employees

2008-10-13T06:58:00.001-04:00

One of the most difficult tasks in the medical office is training new employees. Even when an employee comes to you with lots of experience, it does not mean that the new employee will be able or willing to do things the way you want them done. We find that some of the people we have hired who come to us with experience tend to do things the way they learned in a previous office. That is not always a good thing.

Some new employees learn much quicker than others. When we hire a new person, we try to establish what their strong and weak points are as soon as possible. We find some people are natural at making and answering phone calls and some hate talking on the phone and do not do as good a job. Sometimes when we hire a person for a job we find that they are better suited for a different one than what we intended. We try to work around the employees strong points as long as it works for us. But if we hire someone for a specific job and they are no good at it we find it best to let them go before we waste any extra time in training. If we can use them in another position that they are good at, that is great but if it isn't working, we let them go.

Training a new worker is a huge time consuming job which keeps others from getting their own work completed. If you don't watch all the work they do to make sure it is being done the way you want it done you may find yourself redoing it. This can take longer than it would have taken to do it yourself. Generally speaking we find it takes months to a year before a worker is trained well enough to stop checking their work.

When first starting to train a new employee it is crucial that you check everything they do. As the new employee gets more experience we've learned to spot check the areas we feel were potential problem areas for them. With all the things there are to learn in the medical billing field it takes time to develop a great employee. Once we have a great employee we do everything we can to keep them happy so they stay on. It's so much easier to keep a great happy worker than it is to train a new one.

Secrets to Signing Up Your First Doctor

2008-10-13T06:43:00.002-04:00

We recently completed our latest medical billing e-book and added it to our e-books for sale on our website Medical Billing Live. We wrote this book because so many people starting this business don't understand why doctors hire billing services or how to approach these doctors to get their business. We offered some marketing suggestions as well and explained how important your marketing efforts are, especially at the beginning of your carreer.

When we started our business in 1994 we really did not understand what our worth could be to a medical office. It took years of experience to fully understand why a medical billing service could do a much better job at bringing in the money than many offices can do in-house. Our efforts in this book were to shorten the learning curve for those who want to get started in this business.

ICD10 Codes Go Into Effect in 2011

2008-09-16T10:31:00.002-04:00

Many of us have heard about ICD10 codes but don't understand what the effect of use of the ICD10 codes will mean to individual billers. Well the Department of Health and Human Services has announced a proposal to change ICD9 codes to ICD10 codes effective October 1, 2011. What are the differences and how will this affect all of us in the medical billing field?

ICD10 codes are an important part of the effort to develop nationwide electronic health records. The current ICD9 codes which were developed 30 years ago are expected to run out of available codes next year. ICD9 codes are limited to 17000 codes where ICD10 codes will allow for 155000 codes.

The new codes will help identify specific health conditions and help with the implementation of electronic medical records. As with all changes to the medical billing industry, it will be interesting to see what challenges arise as a result. If it is anything like NPI numbers and new CMS 1500 forms, we will all be in for a surprise.

Dealing With Insurance Denials

2008-09-15T08:36:00.004-04:00

One of the most difficult tasks in the medical office for the billing department is dealing with insurance denials. Unfortunately many claims are denied for a variety of reasons and if not handled properly no payment will ever be made on that service. Most offices are extremely busy and it can be difficult to find the time to take care of these problems. If your office does not have the time and resources to take care of these denials, your receivables will greatly suffer.

Denials can range from no coverage to treatment notes needed. Each individual denial needs to be looked into to determine how you will get paid for that date of service. Many times it will take only a phone call to fix the problem, but that phone call can take as long as 45 minutes to accomplish the preferred outcome. Some denials will entail the resubmission of the claim. An incorrect diagnosis code is an example of this. Some denials will result in billing the patient for the service but it may still take a 30 minute phone call to be sure that you are doing the right thing.

The secret to handling denials effectively is to act as soon as possible on the denial. Many denials have a time frame that must be adhered to. Then, you need a good system in place for dealing with the denial. When a claim is denied find what works best for that problem and use the same method each time you get that denial. Find the most effective solution to each denial and use that solution as soon as you receive the denial.

For instance, when we get a denial for medical records or treatment notes, we immediately type up a note and fax it to the providers office to let them know that we need the records. We then put the denial in the front flap of the folder designated for that provider. As soon as the notes are sent to us we go to the provider's folder and retrieve the denial. We print out a new claim form and attach a copy of the denial and the notes and note the computer that the records were sent with that claim.

Sometimes denials are completely incorrect. Usually a phone call to the insurance company can resolve the problem. We sometimes have claims rejected at the edit stage of an electronic submission for no insurance coverage. A call to the insurance company or sometimes checking their website may tell us that the prefix of the identification number has changed. We change the prefix and resubmit the claim. Or we may have made a typo in the ID# that needs to be corrected.

We have had claims that were accepted, but applied to the deductible. After the patient was billed we received a call from the patient stating that they either don't have a deductible or that it has already been met. Sometimes the patient is wrong and sometimes the insurance company is wrong, but all these challenges must be dealt with if you are to receive payment. The more you delay in dealing with the problems, the better the chances are that you will not be paid.

Letter to an Anonymous Medical Billing Service

2008-07-10T14:16:00.001-04:00

We’re sorry. You lost a client today and they signed up with us. We don’t like to see any billing service struggle to survive. We sincerely don’t like to take a client away from another billing service. There are plenty of new doctors and offices that decide they can’t handle in-house billing any more to try to take a client from another service. But one of your clients called me and asked how I would handle a certain situation.

Please let me tell you why it happened. Your client explained that she called you, her billing service, and asked why they were not receiving payments on a particular patient. You didn’t know. We told her that wouldn’t happen in our office and explained our system of tracking the claims. She told us that her billing service wouldn’t call on a claim unless she called and asked them to. Basically all your service is offering is submission of the initial claim. Anything else is extra work for you.

She went on to tell me that if the office asks the billing service for a report it is weeks before they bring it in. Weeks!! That is totally unacceptable. If the provider requires a report, you should run that report that day and fax it over. They asked for the report because they want it not so they can ask you about it again next week.

STOP!! You have to change that. You are called a billing service because you offer a service. If you offer only the service of submitting the claims, it’s not much of a service. You need to understand that other billing services are offering more than that and you need to step up to compete.

Submitting the claims is only a small part of the job you can offer your clients. Every time you find something else you can do for your clients, you solidify your relationship with them. Tracking your claims is just as important as submitting them. You must start running and working regular aging reports. You need to get a system in place for tracking your claims. You need to be reading your electronic reports and correcting any problems. You need to be reporting regularly to your clients about any problems you are encountering.

We hear enough about billing services providing poor service. Let’s all step it up a little and do a better job for our providers. We offer a valuable service when done properly. Most medical offices are much too busy to handle the billing portion of the work. Make sure you have everything under control with great systems in place for not only submitting your claims, but for tracking them, too.

If your providers are not getting the service that other billing services provide, they may not be happy. They may call me tomorrow.

Signing Up Your First Client

2008-06-17T13:39:00.002-04:00

Signing up your first client can seem like an impossible thing when you are first starting your medical billing business. You may wonder why anyone would let you take care of their income when you haven't proven yourself yet. The first client can be the hardest to find. We have many people contact us about finding that first provider. Even though you may find it difficult, it is not impossible and you must keep working at it until you get the desired result.

In his book "Ready, Fire, Aim" by Michael Masterson, he states that a beginning entrepreneur should be spending 80% of his or her time selling or marketing and 20% on other business things. He says don't go out and buy furniture, rent office space or purchase equipment. Go out and sell. Masterson says there is no business until there are sales.

There are many ways you can look for providers to sign up with your billing service. Find a method that you can work at efficiently and go out and do it. You can go to offices and inquire, you can do a mailing, you can make phone calls, you can advertise, you can watch the ads to find new doctors opening offices, but you must do something.

A few new billing services are lucky enough to have a client before they start their business. We've talked to people who worked in a provider's office and wanted to go out on their own and convinced the doctor to sign up with them. We've talked to others who worked around providers in a hospital setting and found clients that way. Whatever your method, just keep going until you find that first provider. Remember, you don't have a business until you have a customer.

You must learn to look confident about your billing capabilities when you approach possible clients. You can reassure them with your experience even if you don't have any clients yet. Let them know that you will be trying harder than anyone else could because it is so important to you to get it right. Then make sure you do a good job at it when you get that first account. The next one will come much easier.

Timely Filing Denials - How to Get Them Paid

2008-06-13T06:30:00.005-04:00

Isn't it annoying when you submit an insurance claim and get a denial for timely filing. Insurance companies want your claims filed quickly, some within 45 days of the date of service. If you have filed your claims on time and still get a denial for timely filing, here is the process that works for us.

First, deal with it immediately. Do not put it down someplace and think you will get back to it at a later date. Most insurance carriers give you a limited time to appeal a timely filing denial.

Second, print out a new CMS form of the claim. Make sure you print the correct claim, not a different date of service and write TIMELY FILING PROOF ATTACHED on the claim.

Third, print out a patient ledger or an insurance aging report for that claim from your practice management system. If you submitted the claim electronically, you can use a copy of your electronics report that shows the claim accepted.

If the claim was for a secondary insurance, you must also find a copy of the eob (explanation of benefits) from the primary insurance carrier for the correct date of service and attach that to the claim.

Next, staple the claim, aging report, and if necessary the eob together with the claim on top. If the insurance carrier you are appealing the claim to requires an adjustment form, you must also complete the adjustment form.

Mail the claim. That's it.

Starting Your Own Medical Billing Service

2008-05-15T12:12:00.001-04:00

We hear from many readers who are just starting or wanting to start their own medical billing business and have many questions to ask. Last week we heard from someone who has a start up behavioral health billing service and was asking about practice management software. She is trying to work with fill and print software and a separate insurance tracker and finding it not filling her needs.

When you are first starting your medical billing business, most of us don't have a lot of money to invest and we try to skimp where we can. The problem is that there are many things that you absolutely require to get your business going. A practice management system is one of them. A good fill and print software can be great for a small office where there aren't a lot of claims being sent to the insurance companies. But when you need to track the claims to make sure they are all paid, you need a good practice management system.

The practice management system allows you to run reports to let you know what claims are outstanding. It can also total everything for you at the end of the month which may be necessary, depending on how you charge, to bill your clients. Each claim is saved in the software and the payments are entered into the corresponding claim when they are paid. It is really a necessary tool to keep track of all your work.

Practice management software is available in a wide range of prices with a variety of options. If you are shopping for a good software, you first need to know how many computers you want to install the program on.

Multi user and multi practice systems can be confusing, but here's what you need to know. If you are the only person who will be using the software, you can get a single user. If there will be more than one person using the software at a particular time, you need a multiple user or both of you won't be able to use it at the same time.

You will need a multi practice practice management software if you plan on billing for more than one office which most billing services do. This will allow you to separate the offices so you don't have to print Dr. Smith's claims in with Dr. Jones. A good multi user, multi practice software will cost you a minimum of a few thousand dollars. Research this purchase really well because you don't want to try to change systems down the road.

Some of the other things that you will require are a fax machine and a photocopier. You will be making photocopies of any secondary and tiertary claims you file on paper. It can become expensive if you have to make very many copies on your fax machine. You will need some file cabinets to keep track of claims and eobs.

You will also have to plan on keeping your computers up to date. We try to replace one of our computers each year to make sure they will work at optimal performance.

Medical Billing Newsletter Released

2008-04-16T06:01:00.002-04:00

The April issue of our free monthly medical billing newsletter was released yesterday. We've written an article on medical credentialing, on par vs non par and accepting assignment, some info on billing for vision insurance claims, and we've announced the release of our newest e-book "Mental Health Billing Made Easy". You can sign up for our free monthly newsletter here.

Mental Health Billing Made Easy

2008-03-31T14:17:00.003-04:00

I'm happy to announce that our latest book will be released in April. We are finishing up "Mental Health Billing Made Easy". It covers everything a person in the mental health field needs to know to effectively bill insurances and patients. I'll have more info about it in April's newsletter. Make sure you check out all the other books on medical billing we offer.

New CMS 1500 Fill and Print Software

2008-03-26T06:39:00.004-04:00

We've had several people ask and have finally found a "fill and print" software for CMS 1500 forms that we think is an answer to many requests we've gotten from our readers. Speedy Soft offers this for only $99 and it not only fills in your CMS forms just as if you were typing them onto a CMS form, but it also stores the patient info so you don't have to type a repeat patient's demographics in all over again.

It also stores the practice info and diagnosis and prints them on the claims. This type of software is great for the small office that is still handwriting claims or typing them. It is a huge timesaver and very easy to use. The company offers free support and an option to send the claims electronically. They will soon be releasing a version for UB04 forms, also.

Medical Billing Forum

2008-03-20T05:32:00.002-04:00

We've been working hard to put together our new medical billing forum. I've been taking some of the "Ask the Biller" questions that we've gotten over the last year and been moving them to the new forum with the answers we gave. Now the questions are all organized into categories to make it easier to find what you are interested in.

The interest this has generated has been amazing. There are lots of us medical billers out there with questions and answers to other's questions and now we've got a place to share them.

We've had lots of new people signing up and helping us answer the questions with their experiences and knowledge. Thanks to everyone. It can't help but benefit all of us if we can share our problems and challenges and resolutions.

We're excited!! Make sure you visit the Medical Billing Forum and ask any questions you may have or answer any questions you've had experience with.

Diagnosis Codes - ICD10 and DSM IV Codes

2008-01-25T07:10:00.000-05:00

Here's another question from our "Ask the Biller" page.

Hi again! I'm just wondering whether Diagnostic Codes, Line 21 on CMS 1500 are to be exclusively ICD 10 codes or are DSM IV codes also accepted?

Thank you, Carol

We answered:

You can use either ICD or DSM codes in box 21, as long as the codes are recognized by the individual insurance carrier that you are billing.

Question on Billing Sick Child Visit

2008-01-22T07:45:00.000-05:00

Here's another question we received

I am the billing manager for a pediatric office. When we see a sick child for wheezing and/or tightness in the chest we usually bill 99213 for office visit and give them a inhalation breathing treatment under procedure code 94664 but we never get reimbursed for the treatment only the office visit. How do I get insurance companies to consider procedure 94664 am I billing this correctly?

Michele's answer

When you see the patient for the wheezing/tightness and you do the 94664, I would recommend trying a 25 modifier on the E&M code indicating that the E&M was a Significant, Separately Identifiable E&M Service by the Same Physician on
the Same Day of the Procedure or Other Service.

Also, if you have more than one diagnosis and if it is appropriate to use a different diagnosis for the E&M than you use for the 94664 that may help.
For example, if a child comes in with an upper respiratory infection, and you give him a breathing treatment for the wheezing/tightness, then you could bill the 99213 with dx URI and the 94664 with the wheezing/tightness diagnosis.

Hope that helps.

Question on Locum

2008-01-22T07:38:00.000-05:00

We recently received this question

We have an anesthesia group and a pain clinic. We have two anesthesiologist on staff, one is permanent, the other is according to the permanent doctor, a locum. My dilemma is that the pain clinic is in the same building as the O/R, which means they are both in the same building, so is he actually covering for the permanent doctor while he is in the pain clinic, which would make him a locum, or is that not within locum guidelines. Both companies have seperate tax id's and NPI's but are on the same property.

Michele's response

I’m not completely sure I understand your question. Do both anesthesiologists (the perm & the locum) work in both the pain clinic & in the OR? A locum physician is just a temporary physician usually filling in for a permanent physician’s position. Some practices use locums more as a permanent position though. Since a locum is a licensed physician they do not have to work under a physician’s supervision, like a NP or PA. If this doesn’t answer your question, please email me with more details.

Can Your Business Get Too Big?

2008-01-11T06:16:00.000-05:00

If you are a struggling new business I'm sure you wish your problem was that you were growing too large. But the reality is that when you are a growing business it can be difficult to see when you are growing too quickly.

For either the medical office or the medical billing service the same thing applies. When you grow too fast you risk not being able to take care of your customers the best possible way. We found an interesting example of this today.

We signed up a new account today. It was a small account, but his billing was important to him. He had signed up with a billing service in April 2007 and now in January 2008 had not yet received $.01 from an insurance company.

He inquired regularly to his service as to the status of his claims and was assured that everything was in place. Now nine months later he is questioning if he can stay in business.

How can you let nine months go by without a payment and not do something? That can only happen if you grow too quickly and can't take care of the details of your business. The details are critical.

Patients who must wait hours in a waiting room for the doctor are not happy patients. If this is happening in your office, you need to make changes and make them quickly before your practice suffers
If paperwork is required for patients to receive their workers comp checks, this paperwork needs to be completed asap. It is very important to this patient. These are the details I'm talking about.

If you already have too many patients to take care of the ones you have effectively, it is time to stop taking on new patients. If you don't, you will find you are loosing old patients as fast as you are gaining new ones.

This is also true of medical billing businesses. You must do a good job with the accounts you have. The details are critical. If you are too busy posting the payments to work your aging reports, you aren't paying attention to the details.

It's important to remember that whether it is a medical office or a billing service, it's still a business and needs to show a profit. So if you get too busy to take care of the details, you've grown too fast.

UB04 Medical Claim Form Billing

2007-12-24T09:03:00.000-05:00

We recently received this email.

My daughter recently underwent detox in a clinical setting. The insurance company, United Behavorial Health is demanding that the claim be submitted on a UB92. The clinic is unfamiliar with these forms and only uses the 1500. They billed the services as H0008 and H0009 - All inclusive room and board plus ancillary. I found the Revenue Code of 0100 to be the 'companion' to those.

The clinic claims that only hospitals can use the UB92. How can I help them to understand that I cannot recover my $15,000 unless they use this form? Also, is this form extremely difficult to fill out. I'm sure this will be their next issue. They already have their money and now I would like to recover mine.

We gave this lady some suggestions for recovering her money, but we have received many questions lately regarding the use of the UB92 or actually the replacement UB04 form. The UB92 forms are obsolete and have been replaced with the UB04 form which allows for the NPI numbers.

It seems we have been receiving many questions on the use of the UB04 forms. Many clinics are billing only on CMS 1500 forms and getting their claims denied. Because of all these questions, we have added a new page to our website on Clinic Billing and we've published our latest ebook "UB04 Forms - How To Complete A UB04 Form Completely and Correctly - Line By Line, Box By Box"

Merry Christmas

2007-12-24T08:59:00.000-05:00

We would like to express our best wishes for a happy holiday season to all who visit our blog.
Alice & Michele

Question About Locum Tenen

2007-12-24T08:45:00.000-05:00

We recently were asked the question "How do you complete the HCFA 1500 form when using a Locum Tenen?" on our Ask the Biller page.

Michele's answer was "You should be using the locum tenen’s individual NPI & legacy numbers in box 24 J, and their name in box 31. Then the group name address and GROUP npi in box 32 & 33."

There still seem to be many questions of the use of NPI numbers. For more free information on the use of NPI numbers, visit our NPI page.

Electronic Reports Notebook

2007-12-13T14:28:00.000-05:00

If you are sending your medical insurance claims electronically, be sure to read Michele's Blog post on keeping track of these batches of electronic claims in a notebook. You can read about her suggestions at Michele's Blog.

UB04 Instructions Now Available

2007-11-30T13:12:00.001-05:00

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

2007-11-24T06:58:00.000-05:00

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

2007-11-21T06:06:00.000-05:00

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

2007-11-20T14:16:00.000-05:00

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

2007-11-15T13:06:00.000-05:00

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

2007-11-15T12:53:00.000-05:00

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

2007-11-04T14:33:00.000-05:00

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

2007-11-04T13:45:00.000-05:00

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

2007-11-04T13:30:00.000-05:00

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

Sunday Morning

2007-10-21T06:20:00.000-04:00

It's early Sunday morning and I'm just sitting here at my computer thinking about how much things have changed. Our office manager had gall bladder surgery Friday - and she expects to be back to work tomorrow morning. A surgery that once had a several week recovery time has come so far that Shelly will be back on Monday.

In many ways the insurance billing for the surgery has also come a long ways. A few years ago employees sat at typewriters and typed in claims information. It took several minutes to complete a form which was then mailed to the insurance company. The claim was then passed through many hands from the people in the mail room who opened the envelope to the final processor who makes the decision on whether or not the claim is paid. This was a several week process.

Now most of our claims are sent electronically through the computer. Insurance companies love this. It cuts way down on the amount of time employees are handling the claims which cuts down substantially on their costs. Physicians love this. Their payments come much quicker. Problem claims are found much sooner and dealt with before they are denied. This brings their outstanding receivables (or cash) in much quicker.

Now we even have electronic remittances which will post payments automatically to your practice management system. What will we see next?

Are you billing your insurance claims electronically? For more information on electronic claims submissions visit our page on electronic billing.

Qualifiers for Medisoft

2007-10-17T06:19:00.000-04:00

A big thanks to Jan R from Internal Medicine Specialists for her email on qualifiers for Medisoft. We recently had someone ask for a list which we were unable to locate. Here it is.

In reference to the question someone asked about qualifiers (for the Medisoft software) - You can go into the Medisoft website and do a search for qualifiers or I have listed below what the qualifiers are. Hope this helps!
0B - State License Number
1A - Blue Cross Provider Number
1B - Blue Shield Provider Number
1C - Medicare Provider Number
1D - Medicaid Provider Number
1G - Provider UPIN Number
1H - Campus Identification Number
1J - Facility ID Number
B3 - Preferred Provider Organization Number BQ - Health Maintenance Organization Code Number EI - Employer's Identification Number FH - Clinic Number
G2 - Provider Commercial Number
G5 - Provider Site Number
LU - Location Number
SY - Social Security Number
U3 - Unique Supplier Identification Number
X5 - State Industrial Accident Provider Number
This information is typed into the PINS field (under Insurance).

Jan R.

Thanks Jan - we appreciate your help.
Alice

Listing our ebooks on Amazon

2007-10-16T08:56:00.001-04:00

Today we received our ISBN #s so that we can now apply to sell our books thru Amazon.com. It's very exciting for us as in the past we've only offered them for sale on our own website and thru Ebay. We now offer the following books in ebook format.

"How To Complete a CMS 1500 Completely and Correctly - Line By Line, Box By Box".

"How to Start Your Own Successful Medical Billing Business"

"12 Marketing Strategies to Grow Your Medical Billing Business"

We are currently working on "How To Complete a UB04 Completely and Correctly" and hope to have it for sale in November.

Let us know your needs and we'll see if we can work them in.

Alice :)

NPI # in Wrong Box Causes Claim Denials

2007-10-14T07:50:00.001-04:00

We recently signed up two new doctors for our billing service. The reason they decided to use a service was because their Medicare claims were all being denied. These two doctors are not located in New York so we contacted the Medicare office in their area. It took several calls and we went through many automated systems before finally getting to the bottom of the problem.

We thought perhaps the denials were caused because the Medicare PTAN was not entered on the claim. Maybe they were not yet able to accept claims without both the NPI # and the Medicare PTAN. But these claims denied because the providers put their NPI # in box 17B.

This is just another example of how important it is to understand NPI #s. Many offices still do not know they need a Type II NPI #. If you are receiving any claim denials for NPI #s be sure to download our free copy of "NPI Numbers - Everything You Need To Know About NPI Numbers" .

If you are having a problem with claim denials, you need to read our ebook "How To Complete a CMS 1500 (HCFA 1500) Completely and Correctly - Line By Line, Box By Box" . Avoid costly mistakes. Make sure your claims are filed correctly the first submission.

Purchasing Medical Billing Software

2007-10-13T06:44:00.000-04:00

We've had several occasions to look up medical billing software on the internet and always have been frustrated by the sites that sell the software. They ask you all these questions about your practice and how much you want to spend but it's difficult to just compare the different software programs available and find the prices.

Many people ask us on our "Ask the Biller" page about purchasing software. We know about Lytec extensively because we use Lytec every day. We also know about several others, such as Medisoft, Eclipse and Perfect Care as we've had occasion to use them in some of our provider's offices. Some are designed for small practices and some are designed for large groups or hospital billing.

We've decided to put up a page on our website comparing the different medical billing software available. We want to give you an idea of what each of the software packages offers, what type of office they work best for, and how much they cost, etc. We want to use screen shots of each software so you can see what the program looks like before you purchase it and what the cost of each software package is.

Nellie needs help with Medisoft qualifiers

2007-10-11T11:23:00.000-04:00

I recently got this question on our Ask the Biller page.

Do you have a list of the qualifiers that are needed for each area in medisoft (eg. what is the qualifier code when you enter a procedure that is not on your system and the bottom box says code ID qualifier.)? Also the ref dr's need a qualifier and ins co's? Do you have a list of these?

Please share with me...

sincerely,

Nellie

Michele answered

Hi Nellie,
Thanks for your question. I use Lytec, which is similar to Medisoft, but Lytec does not have the qualifier fields like Medisoft does. I tried to find a list of the qualifiers used in Medisoft but I wasn’t able to. The only qualifiers I know of are the ones to identify the type of insurance carrier in electronic claims submission which is not what you are looking for. I will post your question and maybe another Medisoft user could email us if they have lists of qualifiers.

So if anyone can help Nellie, we would appreciate it.

Thanks,
Alice

Newsletter published today

2007-10-08T13:33:00.000-04:00

Hi,

Well, we sent out our free monthly newsletter today. If you are not yet a subscriber, be sure to sign up for your free copy at Solutions Medical Billing.

This month's newsletter covered

starting a new private medical practice
NPI registry website down
Bundling CPT Codes
New look to our website
medical billing and coding schools
projects we are currently working on

If you have any suggestions for articles, let us know. We're here to answer your questions.

See you later.

Alice

HCFA Envelopes too large

2007-10-07T19:28:00.000-04:00

I'm having a bit of a problem with my large HCFA envelopes. According to the new rate increases at the post office my large HCFA envelopes that hold multiple claims unfolded with the address of the insurance carrier showing through the window are one inch too long to be considered a large envelope. They want me to pay a package rate which is quite a bit more than the large envelope rate. Now if the envelope were addressed sideways instead, it would be alright but the height can only be 12" and these envelopes are 13" tall.

I found a solution to the envelopes I have in stock. I fold over the bottom edge and tape it with packing tape to make the envelope only 12" high. The HCFA form we place in the window must then be folded about an inch from the bottom so the address shows through the window.

The problem is that I need to reorder. I hate to have to do this to the next 500 envelopes when thousands of others must be having this same problem and the solution would be in making the envelopes 1" shorter. If anyone out there has any connections with the people who manufacture these envelopes, please convey my wishes.

We use many of these envelopes every week. I don't want to go back to having to print labels for each insurance and putting them in plain envelopes. Has anyone else run into this problem. I'm eager to hear.

Alice

What is Solutions Medical Billing

2007-10-07T13:25:00.000-04:00

Every once in awhile someone sends us an email thanking us for an answer we have provided on the "Ask the Biller" page or for writing our newsletter. I got one today saying thanks for all the information that we share in our newsletter and that it is very helpful to them.

Maybe this sounds a little corny, but we feel good when we help someone. It doesn't take a lot of time to answer a question and sometimes it saves the reader a big headache. When we started our business in 1994, we didn't have anyone willing to help us get answers to our questions. And we had a lot to learn. It wasn't long before others started asking us questions. Mostly they asked us about starting their own medical billing business. Remembering how difficult it was for us to find answers, we vowed to help others so we took the time to answer their questions.

In fact, so many people called us about starting their own medical billing business that we wrote our first book about it - "How to Start Your Own Successful Medical Billing Business" in 1999. We found that people who wanted to start their own business had lots of questions and we could be on the phone for an hour answering them all. There was too much to tell them at one sitting. We've sold hundreds of copies of that book and gotten wonderful response from our readers. We found that we enjoy helping others.

Solutions Medical Billing is a small business, run by myself and my daughter. There are nine of us (all friends) who work on about 50 accounts of a variety of providers. Many of our doctors are within a 20 mile radius and we pick up their information weekly but many of our doctors we've never even met. We've developed a great support team of people we can call on when challenges do arise or when one of our readers asks us a question that we cannot answer.

Don't get me wrong, we're not naive. We have been burned by a few others we thought were trying to help us. We had the choice of being mad at them and never reaching out again or remembering who you cannot trust and go on helping when we can. We just like helping people.

So keep sending your questions to us on our ask the biller page. We'll keep answering them to the best of our ability. If you have any suggestions for our newsletter articles, send them along too. We truly enjoy helping others.

Alice

Welcome

2007-10-07T12:53:00.000-04:00

Hi, welcome to my blog. My daughter/partner Michele and I offer a website on medical insurance billing. We offer help to those in the medical insurance billing field who have questions on our Ask The Biller page. We've decided to take some of the questions that seem to be asked about the most often and write about them on our new blog.

We also publish a monthly newsletter free of charge to anyone interested in reading it. You can sign up to receive your free subscription here. We write about news in our field and offer helpful hints on many subjects from getting your claims paid correctly and quickly to small things that will help the office run more smoothly.

We also offer a few ebooks on the subject of medical insurance billing. You can read about them on our website. Thanks for visiting.

Alice Scott