Third Pary Companies Trying to Reduce Your Reimbursement

One of my providers received a phone call today from a man who represented himself as someone who wanted to release a check to her for services she had provided to a patient, but he just needed to fax her a paper to sign. She got the paper and didn't understand what it was, so she faxed it over to me, Thank GOD!

I've been seeing this over the last year or so. A third party company comes in and gets claims from an insurance carrier. Then they contact the medical provider and try to get them to sign an agreement which basically claims that if they agree to accept a reduced fee, they willget reimbursed quicker! What a crock!

First of all, it doesn't seem legal that these third pary companies can obtain these claims from the insurance carrier. I would think that it breaks some kind of confidentiality. And second of all, an insurance carrier is suppose to process a claim within 45 days of receipt of the claim. If the claim is just for fairly common services, and all the information on the claim is accurate, the claim should be paid in a timely manner anyway. And besides, I've found that by the time they contact the provider and try to get them to sign the contract and then finally pay the claim, the same amount of time has passed that it would normally take for the claim to be processed by the originally carrier.

Besides, why should the provider take a cut in pay? The latest one I received was a 26% reduction from the approved amount. And the incentive is something that is suppose to happen anyway? Timely payment for the services? Doesn't really make any sense to me!

I always advise my providers to just say NO! Do not agree to reduce your fee. We call the original insurance carrier and inquire as to why the claim isn't paid yet. And we call and/or fax the third party company to advise them that the provider is NOT going to participate in their game.

So if you've ever been contacted by one of these third party companies requesting that you accept a reduced fee and you don't feel like paying somebody who has nothing at all to do with the service you provided, then tell them thanks but no thanks! After all, you are already forced to accept the fee that the insurance carrier feels is reasonable for the service you are providing. Why should you take another cut in pay!

Best of luck!

Michele

Click here for tips on appealing denied claims.

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.

There is so much information on those reports that is necessary to keep your accounts receivable in check. I went into an office where the billing girl NEVER checked on electronic reports and NEVER did any followup. They were losing 33% of their receivables every single month! The doctors had no idea. The problem was she had too much to get done and that was what she put on the 'bottom of the pile' that she never got to. Unfortunately that meant that the doctor who owned the practice took a 33% pay cut without a choice.

The electronic reports tell you first and foremost if your entire batches of claims were received or not. Just because your file goes from your end doesn't mean it was received at the other end. Sometimes something as stupid as a "#" in an address can cause an entire batch of electronic claims to be rejected. If you are not checking your reports, that means that you don't get paid for the entire batch of claims due to one clerical error on one claim.

Sometimes your electronic batch will be accepted initially at the front end, but after the file is processed the batch gets deleted do to an error. You will receive a report if this happens. I recently had one provider's Medicare batches being denied because there was a discrepancy with the NPI number on the claims and the NPI number that Medicare had on file. The files were initially received ok but then the batches were deleted.

One of the other types of reports you will receive are specific payor reports. These will tell you if a patient's insurance is terminated, or if their date of birth is incorrect, etc. If you do not correct these issues, not only will you not get paid for that claim, but if the patient returns all the future claims will be denied as well.

You may not feel that you have the time to be checking these reports, but I hope that I have convinced you how important it is that you make the time. If your practice should be bringing in more money than it is and you are not checking your reports, that is most likely the reason.

Thanks
Michele

NPI Registry Back Up

Yeah! The NPI Registry is back up. You can once again look up NPI numbers on the internet. For us, this is a huge time saver. I hate to call a busy provider's office and ask for a Dr's NPI number. Also, I'm getting back some claims stating the NPI number is invalid. I like to double check the number before calling to see what the issue is. So for all of you that are always needing to call to get a provider's NPI number, try using the NPI registy to look it up!

Thanks
Michele

NPI Numbers Which One To Use

Everyday I get at least one question on which NPI number is used for what purpose. There is still a lot of confusion out there.

If you have a tax ID# and a group name then you would have a group NPI number (type II) and then an individual NPI number (type I) for each individual provider within the group. When you bill you would indicate the individual provider who performed the services NPI number
in box 24K on the CMS form. Then you would indicate the group NPI number in box 32a and 33a.
The NPI that is in box 33a is who the insurance carrier will make payment to. For example, if you have 2 providers in your group and you put one of the provider's individual (type I) NPI number in box 33a, then the check will be made out to that individual provider instead of the group. You need to put the individual's NPI in box 24K and the group NPI in 33a.

Another common question is "Why do I need 2 NPI numbers if I am the only provider in the group?" Well, even if you are a solo provider but you are using a group name and tax ID# then you will need that second NPI number to be paid properly by the insurance companies. The individual NPI is associated with a provider's social security number, not a tax ID#. If you want your payment under your tax ID# then you need to have a group NPI to bill under.

Whether you agree with how they developed the system or not, if you don't use the NPI numbers the way they were intended to be used you won't be reimbursed properly for your services. So I guess we will all just have to play along by their rules!

Play nice :)

Michele


P.S. For more information on NPI numbers and how to get them visit my webpage on NPI numbers.

Medical Billing & Coding School

I have people ask me all the time about Medical Billing & Coding Schools. What is a good one? Do I recommend taking the courses? Will it help me to get a better job in the field?

There is no easy answer to that question. There are some courses and schools out there that legitimately teach you what you need to know about Medical Billing and Coding, but there are also a lot of bad ones.

We had an student from a Syracuse school call us a year ago and ask if we would take her as an intern. She was just finishing up her course on billing and coding and needed to do an internship with a local business. Her course was taught on the same medical billing software that we use so we thought it would be a big help to us also. We agreed to the internship.

Well, to make a long story short, we called her in near the end of the internship and asked her how much she had paid for the course. She knew nothing about medical billing or coding and she wasn’t even that good on the software.

My stepdaughter’s mom just completed a year long Medical Billing & Coding course in southeastern PA. She and about half of her class are now suing the school for their money back. The school did not teach them all that they claim to teach, and they did not provide them with their certificates and they didn’t assist them with any job searches, all of which was promised before the class began.

While it is not required that you take a course in order to get a job in the medical billing & coding field it certainly can be helpful especially if you don’t have a lot of background. However, there is no substitute for on the job experience.

What I would recommend if you are convinced you want to take a Medical Billing & Coding Course is that you do a little background checking on the school and the instructor. See if you can speak to a few people who have already completed the course. Get in writing exactly what the course will cover and what the school states they will do for you.

The last thing you want to do is spend 12 months in school to be in the same place you were before you started!

Good luck!

Michele

P.S. If you already have Medical Billing experience and you are thinking of starting a Medical Billing Business we wrote an ebook to help people get started. Visit my webpage on
How To Start Your Own Medical Billing Business.

If you've started a medical billing business but you need to grow or are looking for marketing tips, visit 12 Marketing Strategies To Grow Your Medical Billing Business.

NPI Registry Down Until Further Notice

Well it was great while it lasted -- and hopefully it will be back soon. But for now the NPI registry that was up and running for about 2 weeks, which allowed you to look up providers’ NPI numbers on the internet has been taken off line. CMS states that the reason for the closure was “recent instability” with the system. Of course there is no real way to know what that means exactly, but I’ve heard that they are finding that some NPI numbers reported to them were not accurate. In fact, Medicare has been returning or denying claims by some providers stating that the NPI number on the claim does not match the NPI number on file with CMS.



It was so nice to be able to go and plug in the provider’s name and state and get the NPI number immediately. I hate having to call and bug office staff for the information. But, I guess we have no choice until the system is back up and running. They do say it will be back up and running again, hopefully soon!


For more information on NPI numbers, visit my NPI Number Page.

Thanks
Michele

Bundling Of CPT Codes

What exactly is "bundling" anyway? Bundling is when an insurance carrier combines two or more CPT codes, substituting one overarching code, often ignoring modifiers along the way. Bundling can cut down on your receivables because by bundling the codes together they are only allowing the fee schedule allowance for the one code that they feel is appropriate.

There are ways to get around bundling. First you need to make sure you are billing the claim properly on the initial submission. For example, if you are billing for an E&M code for a patient who comes in with high blood pressure but the patient is also complaining of knee pain and you end up doing an aspiration of the knee joint, then you need to make sure you use the correct modifiers to indicate what you are doing. For example, you want to bill the E&M code, say it is a 99213, with a 25 modifier to indicate that it is a separate and distinct service provided during the same visit. Then you would bill for the aspiration of the knee joint with the appropriate code using a 59 modifier to indicate a distinct procedural service.

When the claim is processed and you receive the EOB (explanation of benefits statement) you need to make sure they allowed both codes separately. After all, you did an office visit to manage to high blood pressure and you did the aspiration which was completely separate from the office visit. If the insurance carrier bundles your codes you should file an appeal. In many cases the insurance carrier will reprocess the claim and unbundled the codes if you ask for an appeal.

The appeal doesn't have to be complicated. It can be a form letter that you design where you just need to fill in the blanks. A lot of carriers bundle the claims on initial processing because the majority of offices will not appeal the claim. Just think how much money they save!
You may think that it's not worth the time to appeal but you may be surprised if you knew how much money you actually lost over time. If you have a system in place to file the appeals that is a fairly simple process it won't take much time and you can increase your receivables. In my opinion, it is worth the effort.

For more information on how to increase your receivables visit my webpage on Increasing Your Receivables.

Thanks
Michele