AAHAM Certification In Billing

Some jobs are now requiring employees to be certified in billing.

AAHAM offer certifications for
CPAM Certified Patient Account Manager
CCAM Certified Clinical Account Manager
CPAT Certified Patient Account Technician
CCAT Certified Clinical Account Technician
CCT Certified Compliance Technician

The exam is offered twice a year. For more information visit AAHAM


HIPAA Violations

Did you know there are penalties for breach of patient information even if it is unintentional? Penalties can range up to $250,000 and/or up to 10 years in prison. If you are going to hire someone in the medical billing field, it is your responsibility to make sure you and your staff are up todate. To learn more visit American Medical Association


What Do You Do If the Insurance Companys Pays the Patient?

If the insurance companies pays the patient, then you can send your bill to the patient. It is best to get the date it was paid to the patient and when it was cashed because most patients will say they never received it but seems to remember when you give them all of the details.

If the provider participates with the insurance company, make sure that you check accept assignment on the HCFA form to avoid having future checks sent to the patient. If the provider doesn't participates, you can bill the patient directly up front in the future and have them submit their own claims in the future.

Acronyms for Medical Abbreviations

You can find most of the medical billing abbreviations at Global RPH

Some Common Diagnosis Codes for Family Physicians

Family Practice Management list most updated ICD-9 codes for family physicians.

ICD-9 updates and changes


Medical Billing Contracts

If you are going to try and create your own medical billing company, you should have a medical billing contract. You can either have a basic contract, or have an attorney draft up a contract.

In the contract there are some things to consider

Name of the billing company and the name of client.

Effective date of contract and expiration date if any.

Where will the insurance payments go to? I recommend having the payments go to the physician's office to avoid any legal matters. There should be a contract stating the provider will send copies of EOB's of all payments.

Providing monthly reports or meeting once a month or quarterly.

How will payments be made? You can either charge by percentage. Some of the average ranges are 8 to 15% or an average of $4 to $10 per claim. Things to consider are the patient volume, average income and if the client is established or not.

Who will do the coding? You will want to interview the company that you will be outsourcing with to make sure they are not doing anything illegal first. You do not want to do billing for a company that is in violation.
Once you have interviewed with them, you can either agree to have coding stay with them or choose to outsource coding as well for an additional fee.

Things that the client is responsible for:
provide true and accurate data(the client will be responsible for any submission of false date that can be prosecuted by law)
verify insurance
client will be responsible for his/her own credentialing
client will not offer kickbacks or professional courtesy to client(this means the client can not wave copay or give free services to preferred patients, THIS IS AGAINST THE LAW)

Note that claims and patient information belongs to the property of the client and the billing company is only using it while contracted with the client.

Billing company is responsible for
following up on unpaid claims
patient billing
paper and electronic submission of claims

Where to Apply For A NPI Number?

If you need a NPI number, the National Provider Identifier, number here is the information that you need to apply apply for NPI number


Can I Wave Co-pays at the Doctors

You shouldn't wave copays at the doctors. This is considered a professional courtesy. If you tell a patient they don't have to pay a copay that the insurance company contracted with you for them to pay, then most insurance companies will consider this as fraud. They will view this as a kick back or an intice on your behalf to get patients to come to your practice. The only way a copay should be written off is if faith efforts were considered by the patient to pay the copay(after bills have gone out to the patient)and they have written a financial hardship letter with proof explaining that they can not afford the bill.


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