Medical Billing Software From Home

There are alot of billing software that can help you start your business. The only one that I have experience with is Medisoft. I purchased a version of Medisoft a few years ago for only $199. This was all I needed to bill claims for a small doctor from home. This was enough to support my billing needs and I didn't have to spend alot of money either. Prices have gone up since then but it is for a reasonable price. If you are interested in another software, please do extensive research before purchasing.

Insurance Follow Up

When a claim is outstanding and there is no response from the insurance company, we need to call the insurance company to check the status of the payment or denial. When doing follow up, the insurance company will ask for your name, number, tax id, provider names, pt name, policy #, date of service, date of birth, charge amount and sometimes providers address.

Example we’ll use

Tax id 52-1234567
Provider Dr. John Jones
Provider Address Po Box 1234, anywhere city, state, zip
Policy number 256RL6523
Pt name, Jill Jackson
DOB 11-01-1955
DOS 1-12-2006
Charged amount $300


Example call:
ABC Insurance Co: ABC Insurance Co Lisa speaking can I get your provider #
You: 52-1234567
ABC Insurance Co: Who am I speaking with?
You: Amy
ABC Insurance Co: Is there a call back number for you.
You: 410-555-1212(this is your office number)
ABC Insurance Co: What is the name of your provider?
You: Dr John Jones
ABC Insurance Co: Patients name and DOB
You: Jill Jackson 11-1-55
ABC Insurance Co: And the Patients policy number?
You: 256RL6523
ABC Insurance Co: DOS and charged amount
You: 1-12-06 $300
ABC Insurance Co: Thanks, how can I help you?
You: I need to know the status of payment
ABC Insurance Co: Ok I’ll check the status for you.
You: Thanks

The insurance company will either tell you when the claim was paid or tell you if it was denied.

Medical Billing Job From Home

Finding a medical billing job from home is like finding a needle in a haystack. Is it possible? Yes, but 95% are scams. Most billers who work from home started out in an office and under certain circumstances their employer allowed them to work from home. Other ways you can work from home is to go into the business for yourself.

New HCFA Forms

New HCFA Forms are coming. Are you ready? Eventually anyone sending claims on the old HCFA1500 forms will start to reject. To read more about the changes visit this website. http://www.nucc.org/

Learning Health Insurance for Medical Billing

HMO- (Health Maintenance Organization)- most non emergency treatment needs PCP, normally requires referrals to go to different specialties.

PPO- Preferred Provider Organization- a selected network of providers. Usually no referrals required. Usually have copays.

POS- Point of Service- a hmo plan with option to opt out of network without a referral for a higher fee.

Indemnity Insurance- covers large amount of network providers. Pt Usually have a 20% coinsurance.

Government Programs-(to help assist the elderly, disabled and low income)
Medicaid- funded by the state. No fees to the patient
Medicaid Family Planning Only(visits related to contraceptive management)
MCO-Medicaid HMO or Managed Care Organization
CHIP (Children Health Insurance Program) no premium, no copays for pregnant women
and children.
CHIP premium- Low cost monthly premium to parents with higher incomes
Medicare- Normally for patients over 65, or young patients with disabilities or people
with End Stage Renal Disease.

What is HIPAA?

HIPAA- is the Health Insurance Portability and Accountability Act of 1996
This law covers the privacy and security of medical records and protected health information. When we take patients information it is not to be shared with anyone unless it is work related. If a patient calls requesting information about their visit, ask them to fax something in writing authorizing release. If you give out patient information over the phone to the wrong person, you can be sued so its better to take every precaution necessary.

Sending Your Claim to the Insurance Company

If you are billing for a physician charge, you will bill your claims on a HCFA 1500 aka CMS 1500 form. You can see a sample here HCFA 1500 form

If you are doing facility or hospital billing only then you would use a UB92. You can see a sample UB92 here Sample UB92

To keep updated with constant changes of this form go to www.cms.gov

Insurance Company Payments

What is Payment Posting?

Payment posting is simply posting payments from the insurance company into the system. The insurance company sends a check along with an EOB. On the EOB the insurance company will tell you the allowed amount and the amount they paid. You would then bill the patient any copays, coinsurance or deductibles.

What is an EOB?

EOB means Explanation of Benefits. Insurance companies send information to both the patient and provider on exactly what they paid and allowed. Allowed amount means the maximum amount the insurance company would consider for payment. Any difference above the allowed amount is written off if the provider participates with the insurance company.

Example. The charged amount for the doctors’ visit was $100. The insurance company allowed $70($30 gets written off write away if the doctor participates) out of the $70(they allowed) they pay $50 and states patient has a$20 copay. The $50 they paid plus the $20 copay equals the allowed amount of $70.

If the doctor doesn’t participates with the insurance then the patient is liable for any balance left over after the insurance company pays. In this example, the patient would have to pay the $20 copay and the $30 since the doctor doesnt participate. The patient would be liable for $50 since the insurance company only paid $50. This is because the doctor doesn't participates.

ICD-9 and CPT Code

What is an ICD-9 code?(International Classification Of Disease)

Icd-9 is a diagnosis. The diagnosis is the reason a patient is being seen. For example: a patient comes to see the doctor for a headache. The diagnosis would be headache. A number is assigned to this by a coder. They choose the appropriated diagnosis code from the ICD-9 book and code it on the encounter form.

What is a CPT code?(Current Procedural Terminology)

Cpt code is the procedure that is being done. Ex. A new patient comes in to see the doctor for the headache, the doctor examined the patient. The cpt code would be a new office visit. The coder would then choose the appropriate cpt code from the CPT book and code it on the encounter form. Examples 99201-99205 are new office visit codes in the cpt book. Depending on how long the patient was seen determines the level and should be done by a certified coder or someone who has experience.

What is an encounter form?

You may have seen it before. This is the form the doctor attaches to your chart to give to the lady at front desk. This form has your demographic information along with insurance information. The office usually picks frequent icd-9 and cpt codes that they use often and preset it on the form. Most of the time the doctor will check off what diagnosis (icd-9) and procedure (cpt) they used and give to the person that will do the charge entry.

What is charge entry?

Charge entry is just entering the cpt codes and icd-9. The registration(the patients information, name, date of birth, social security number, address, insurance, etc) is usually already done by someone else who just does registration. When you are doing charge entry you enter information that is on the encounter form. Along with the patient demographics, you need to enter the date of service, the cpt code, the icd-9 and the charge amount if needed. Sometimes you need to put in the authorization number or referral information.

Other information that is needed to get the claim paid is normally preset to come out on all claims from the initial set up such as the provider tax id and address.

Medical Billing

When a patient is seen at the doctor or hospital, charges are sent out to the insurance company for their visit. We send those charges provided by the physician or hospital to the insurance company. The insurance company then determines if the claim will be paid and if the patient has a copay or coinsurance. Once they have process the claim, they send the provider a check along with an EOB(explanation of benefits) for the patient. If the patient has no insurance, we just simply bill the patient directly for the bill.