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
Monday
Medical Billing Contracts
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
Thursday
Wednesday
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.
Friday
Privacy Policy
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Wednesday
Medical Billing Schools
To obtain a career in medical billing, you do not have to take a course. Coding and billing are different from one another. Coding is linking a code to a diagnosis and cpt code. Remember a diagnosis (or dx for short) is the code that describes what is wrong with a patient and the cpt code is the code that describes what is being done. If you decide to become a coder then this is something that you should go to school for but billing is different. Alot of people think medical billing and coding are the same thing but they aren't.
If you don't have any experience in billing, try starting through a temporary service. They will help get you in the door through a front office assignment. Front office jobs are easier to start with. Example of a front office job is taking patient copays and setting up appointments. From here you can easily get office training on other billing functions and in no time you can start your career in medical billing.
Saturday
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.
Thursday
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.
Wednesday
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.
Monday
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/