Loading ...
Sorry, an error occurred while loading the content.

Re: [MedicalBillers] needing advice

Expand Messages
  • Resean Bady
    ... From: Dottie Hanussak To: Sent: Friday, July 14, 2000 9:26 PM Subject: Re: [MedicalBillers] needing
    Message 1 of 6 , Jul 14, 2000
    • 0 Attachment
      ----- Original Message -----
      From: "Dottie Hanussak" <dottieh5@...>
      To: <MedicalBillers@egroups.com>
      Sent: Friday, July 14, 2000 9:26 PM
      Subject: Re: [MedicalBillers] needing advice


      > Hi Annissa,
      >
      > Must say your post has me intrigued and with questions.
      >
      > ----- Original Message -----
      > From: Annissa Bady <chailocks@...>
      > To: <MedicalBillers@egroups.com>
      > Sent: Friday, July 14, 2000 8:55 AM
      > Subject: [MedicalBillers] needing advice
      >
      >
      > <SNIP>
      >
      > > I'm thinking about hiring the Professional's Choice Software company
      > > to secure doctors for me, but when I talked with the man he basically
      > > gave me the heebee geebees again.
      >
      > If he gives you the jitters, stay away.

      He doesn't give me jitters as far as the legitimacy of his business, but as
      far as how technically proficient I need to be before I enlist his services.
      This is why I'm trying to find out what I absolutely need to know before
      starting and what is okay to learn along the way. He suggested taking a
      medical billing course...I am taking his suggestion seriously and am
      presently looking for courses to take at home or through a community
      college.

      > Many MD's look to you, since you billed it, to offer ways to get a denied
      > claim paid. Can you give these ways?

      Other than providing the doctor with notification of the yearly changes made
      to his/her codes which are published in the cpt, icd, and hcpcs indexes, I
      could not tell them how to get a claim paid other than making sure all the
      info is correct. From what I understand, since I am looking to be an
      at-home, 3rd party biller, I have no legal right to code in the first
      place...but I should still have the code books available so that I at least
      have some reference to help keep the doctor and myself up-to-date?


      From what I understand from the marketing company that I will be using, the
      doctors that sign on to me will be providing already coded superbills.
      After inputting the correct information, my software checks for missing or
      incorrect info, and the clearinghouse rechecks and sends a report detailing
      reasons for rejection. From what I understand, my responsibility if there
      is a rejection will be to correct it myself if it was my mistake. If it is
      information that the doctor needs to correct such as coding or needing to
      provide a referral name or authorizations, etc. then I can contact the
      office to get that info.

      My next question is, if I'm going to only be doing electronic/paper claims
      processing whether one medical billing course through a community college
      with proof of completion through transcript will be enough, or whether I
      should go through a certification program where I'd get a certificate or
      some type of diploma?

      Sincerely,
      Annissa B.
    • Dottie Hanussak
      Hi Annissa, Must say your post has me intrigued and with questions. ... From: Annissa Bady To:
      Message 2 of 6 , Jul 14, 2000
      • 0 Attachment
        Hi Annissa,

        Must say your post has me intrigued and with questions.

        ----- Original Message -----
        From: Annissa Bady <chailocks@...>
        To: <MedicalBillers@egroups.com>
        Sent: Friday, July 14, 2000 8:55 AM
        Subject: [MedicalBillers] needing advice


        <SNIP>

        > I'm thinking about hiring the Professional's Choice Software company
        > to secure doctors for me, but when I talked with the man he basically
        > gave me the heebee geebees again.

        If he gives you the jitters, stay away.

        > Is electronic billing really that difficult?

        Depends on the specialty you bill for, the way your MD charts, or sends you
        the info to bill, whether you have to call for pre-certs or not,
        application of modifiers correctly, and also which insurances you would be
        billing. Electronic billing is no easier than paper claims as you still
        have to know what is what.

        > Here's what I thought:
        >
        > ~I needed to be aware of codes and how they are used, but I don't
        > need to be a certified coder to process electronic claims.

        You need knowledge of the dx codes, prodedure codes, modifiers, HCPCS codes,
        and HOW, IF AND WHEN TO USE THEM. (emphasis, not shouting.) You need a MD
        who will code things for you since you have so little to no experience. You
        need to be able to decifer why an insurance would deny the code and
        what to do about it if you are a full service center. You need to be able to
        write a good dispute letter with valid reasons why the insurance should not
        have denied the claim unless the office you are billing for would do this.
        Many MD's look to you, since you billed it, to offer ways to get a denied
        claim paid. Can you give these ways?


        > ~To process an electronic claim you need all the patient registration
        > information and insurance information. I submit it through my

        All the registration info, the diagnosis and codes for it, the procedure
        codes, the modifiers, a referral if needed, depending on specialty, date
        last seen by patients primary, and more.

        > clearinghouse making sure all the information is correct. I do
        > follow-up on rejected claims and correct claims that the
        > clearinghouse indicates need correcting. The doctor receives the EOB
        > along with payment. I prepare audit/aging reports and provide these
        > to the doctor weekly or monthly.
        >
        > Isn't it that simple or am I mistaken. I just want to start off
        > doing electronic billing and maintaining confidential patient
        > records. The patient billing will come later I think.

        I personally do not feel it is so simple. And you also have to keep up with
        insurance rule changes (which happen often). You have to keep up with
        changes/deletions of diagnosis/procedure codes. Who will do the insurance
        verification, you or the office.

        > MY BIG QUESTION, I'M DOING LOTS OF READING AND AT-HOME PREPARATION.
        > DO I REALLY NEED TO TAKE AND 8 MONTH PROGRAM TO JUST DO ELECTRONIC
        > BILLING OR AM I PUTTING MYSELF IN JEOPARDY OF MESSING EVERYTHING UP
        > IF I GO AHEAD AND GET A DOCTOR TO DO ELECTRONIC CLAIMS FOR?

        Why do you say " TO JUST DO ELECTRONIC BILLING"? You make it sound like it
        is a snap, and it is not.

        Can you tell if the MD gives you the right code or the wrong code and why?
        And then you would have to get in touch with the office and get them to give
        you the right code, or depending on your contract with them, get the right
        code yourself?

        Can you keep up with what Medicare visits have to be spaced at specific
        intervals?

        If you get a Doc who will do all the coding for you, the disputing the
        denials and so forth, maybe some of your problems are solved. You STILL have
        to be able to tell if what you are coding is right or wrong as "you" would
        also be liable for fraud.

        Hope this helps.
        DottieH5
        dottieh5@...
        Express Medical Billing


        > Sincerely,
        > Annissa Bady
        >
        >
        > ------------------------------------------------------------------------
        > To email plain text is conventional, to add graphics is divine.
        > We'll show you how at www.supersig.com.
        > http://click.egroups.com/1/6811/8/_/100837/_/963590216/
        > ------------------------------------------------------------------------
        >
        > A list where we can all help each obtain maximum reimbursement!
        >
        >

        _______________________________________________
        Why pay for something you could get for free?
        NetZero provides FREE Internet Access and Email
        http://www.netzero.net/download/index.html
      • Dottie Hanussak
        ... From: Resean Bady To: Sent: Friday, July 14, 2000 5:40 PM Subject: Re: [MedicalBillers]
        Message 3 of 6 , Jul 14, 2000
        • 0 Attachment
          ----- Original Message -----
          From: Resean Bady <chailocks@...>
          To: <MedicalBillers@egroups.com>
          Sent: Friday, July 14, 2000 5:40 PM
          Subject: Re: [MedicalBillers] needing advice


          >
          > ----- Original Message -----
          > From: "Dottie Hanussak" <dottieh5@...>
          > To: <MedicalBillers@egroups.com>
          > Sent: Friday, July 14, 2000 9:26 PM
          > Subject: Re: [MedicalBillers] needing advice
          >
          >
          > > Hi Annissa,
          > >
          > > Must say your post has me intrigued and with questions.
          > >
          > > ----- Original Message -----
          > > From: Annissa Bady <chailocks@...>
          > > To: <MedicalBillers@egroups.com>
          > > Sent: Friday, July 14, 2000 8:55 AM
          > > Subject: [MedicalBillers] needing advice
          > >
          > >
          > > <SNIP>
          > >
          > > > I'm thinking about hiring the Professional's Choice Software company
          > > > to secure doctors for me, but when I talked with the man he basically
          > > > gave me the heebee geebees again.
          > >
          > > If he gives you the jitters, stay away.
          >
          > He doesn't give me jitters as far as the legitimacy of his business, but
          as
          > far as how technically proficient I need to be before I enlist his
          services.
          > This is why I'm trying to find out what I absolutely need to know before
          > starting and what is okay to learn along the way. He suggested taking a
          > medical billing course...I am taking his suggestion seriously and am
          > presently looking for courses to take at home or through a community
          > college.
          >
          > > Many MD's look to you, since you billed it, to offer ways to get a
          denied
          > > claim paid. Can you give these ways?
          >
          > Other than providing the doctor with notification of the yearly changes
          made
          > to his/her codes which are published in the cpt, icd, and hcpcs indexes, I
          > could not tell them how to get a claim paid other than making sure all the
          > info is correct. From what I understand, since I am looking to be an
          > at-home, 3rd party biller, I have no legal right to code in the first
          > place...but I should still have the code books available so that I at
          least
          > have some reference to help keep the doctor and myself up-to-date?
          >
          >
          > From what I understand from the marketing company that I will be using,
          the
          > doctors that sign on to me will be providing already coded superbills.
          > After inputting the correct information, my software checks for missing or
          > incorrect info, and the clearinghouse rechecks and sends a report
          detailing
          > reasons for rejection. From what I understand, my responsibility if there
          > is a rejection will be to correct it myself if it was my mistake. If it
          is
          > information that the doctor needs to correct such as coding or needing to
          > provide a referral name or authorizations, etc. then I can contact the
          > office to get that info.
          >
          > My next question is, if I'm going to only be doing electronic/paper claims
          > processing whether one medical billing course through a community college
          > with proof of completion through transcript will be enough, or whether I
          > should go through a certification program where I'd get a certificate or
          > some type of diploma?
          >
          > Sincerely,
          > Annissa B.
          >
          >
          >
          >
          > ------------------------------------------------------------------------
          > Get great brand name shoes with just the click of a mouse. Check out
          > the huge selection at Zappos.com, the Web's Most Popular Store!
          > http://click.egroups.com/1/6994/8/_/100837/_/963621880/
          > ------------------------------------------------------------------------
          >
          > A list where we can all help each obtain maximum reimbursement!
          >
          >

          _______________________________________________
          Why pay for something you could get for free?
          NetZero provides FREE Internet Access and Email
          http://www.netzero.net/download/index.html
        • Dottie Hanussak
          Hi Annissa, ... as ... services. ... Okay, now I understand what you mean with him. I feel you need a strong background of medical terminology, anatomy
          Message 4 of 6 , Jul 14, 2000
          • 0 Attachment
            Hi Annissa,

            <SNIP>
            > > > I'm thinking about hiring the Professional's Choice Software company
            > > > to secure doctors for me, but when I talked with the man he basically
            > > > gave me the heebee geebees again.
            > >
            > > If he gives you the jitters, stay away.
            >
            > He doesn't give me jitters as far as the legitimacy of his business, but
            as
            > far as how technically proficient I need to be before I enlist his
            services.
            > This is why I'm trying to find out what I absolutely need to know before
            > starting and what is okay to learn along the way. He suggested taking a
            > medical billing course...I am taking his suggestion seriously and am
            > presently looking for courses to take at home or through a community
            > college.

            Okay, now I understand what you mean with him. I feel you need a strong
            background of medical terminology, anatomy and physiology would be helpfull,
            ICD9, CPT, and so forth befor eyou start. What you would be learning as you
            go along is varied tricks (legitimate ones that is) to use to make sure
            claims get paid. By this I mean, what modifiers, when and if to bill with an
            operative report, and things like that. Getting a Doc to bill for without
            previous experience is not easy. Getting a Doc to bill for without previous
            experience AND without adequate credentials is even worse.

            > > Many MD's look to you, since you billed it, to offer ways to get a
            denied
            > > claim paid. Can you give these ways?
            >
            > Other than providing the doctor with notification of the yearly changes
            made

            Annissa, all code books do this at the back of the book, or front (for
            some). Medicare sends out a yearly list of added, revised or deleted codes
            to all Docs.

            > to his/her codes which are published in the cpt, icd, and hcpcs indexes, I
            > could not tell them how to get a claim paid other than making sure all the
            > info is correct. From what I understand, since I am looking to be an

            You could advise them if they ar eusing the wrong code or if they need a
            modifier, oir if they need to attach an operative report. You could advise
            them how to bill for a compensation case, as in, that you have to call the
            insurance company to get clearance before you treat, and so forth. You do
            have to have enough knowledge to know if they are coding correctly or not as
            you are the one billing and as it is your business, you are supposed to
            know. you could get into troube if you bill for something that could be
            interpreted as fraud. You sent the claim! You need a system where as when
            the Doc sends you the claim (or you pick it up) you have some kind of paper
            work that they wrote to send in the claim with the code they chose on it.
            There is so much that it is hard to put it all into an email.

            > at-home, 3rd party biller, I have no legal right to code in the first
            > place...but I should still have the code books available so that I at
            least
            > have some reference to help keep the doctor and myself up-to-date?

            No legal right, no. BUT you need to know enough to be able to know if you
            are billing correctly. Would you?

            >
            > From what I understand from the marketing company that I will be using,
            the
            > doctors that sign on to me will be providing already coded superbills.

            There is a site on the internet called (I think) bizopsmarts.com
            or something like that. Check this guy out before you get into this. From
            what I have heard over the years, those guys who promise you Docs to bill
            for do not always come through like they say. Or, they get you one for 6
            months and that's it.

            > After inputting the correct information, my software checks for missing or
            > incorrect info, and the clearinghouse rechecks and sends a report
            detailing
            > reasons for rejection. From what I understand, my responsibility if there
            > is a rejection will be to correct it myself if it was my mistake. If it
            is
            > information that the doctor needs to correct such as coding or needing to
            > provide a referral name or authorizations, etc. then I can contact the
            > office to get that info.

            You should make up your own form with space for this info to be added BEFORE
            you bill. It is not the job of the clearing house to be this much of a
            checking your work. I get the impression this is what you are relying on.

            > My next question is, if I'm going to only be doing electronic/paper claims
            > processing whether one medical billing course through a community college
            > with proof of completion through transcript will be enough, or whether I
            > should go through a certification program where I'd get a certificate or
            > some type of diploma?

            There are more options than this. If you want to own your own billing
            business, being certified would be a definite asset. This is still what I
            have to do as yet. There are many different types of certifications and many
            different places which offer this.

            I know NEBA, the National Electronic Billing Alliance offers certification
            for the most reasonable price.
            PAHCOM, MGMA, AAPC, and more. All of these can be found on the net.

            I think you should invest in the NEBA course. It is two fold and offers
            billing training as well as how to set up and run your own business.

            Annissa, many people make it sound so easy, but it is not. You can pull
            this offf if you want to, but it will take time and study.

            DottieH5
            dottieh5@...
            Express Medical Billing


            > Sincerely,
            > Annissa B.
            >
            >
            >
            >
            > ------------------------------------------------------------------------
            > Get great brand name shoes with just the click of a mouse. Check out
            > the huge selection at Zappos.com, the Web's Most Popular Store!
            > http://click.egroups.com/1/6994/8/_/100837/_/963621880/
            > ------------------------------------------------------------------------
            >
            > A list where we can all help each obtain maximum reimbursement!
            >
            >

            _______________________________________________
            Why pay for something you could get for free?
            NetZero provides FREE Internet Access and Email
            http://www.netzero.net/download/index.html
          • Resean Bady
            Okay, thank you for the advice....=) Sincerely, Annissa B.
            Message 5 of 6 , Jul 15, 2000
            • 0 Attachment
              Okay,

              thank you for the advice....=)

              Sincerely,
              Annissa B.
            • reeki8@aol.com
              Message 6 of 6 , Jul 17, 2000
              • 0 Attachment
                <<I know NEBA, the National Electronic Billing Alliance offers certification
                for the most reasonable price.
                PAHCOM, MGMA, AAPC, and more. All of these can be found on the net.

                I think you should invest in the NEBA course. It is two fold and offers
                billing training as well as how to set up and run your own business.

                Annissa, many people make it sound so easy, but it is not. You can pull
                this offf if you want to, but it will take time and study.>>

                Hello Annassia and Dot,

                Your words and advise are so true. Not only will you have to arm yourself with tools to run a "cash friendly" business..you must also arm yourself with the tools to protect yourself.

                It used to be ..that a biller was not held liable for the physicians accounts..but all of this is changing and from the seminars I am attending this year they say that "Not Knowing" is not a defendable position if there should be a audit. The last seminar I attended with Medicare present warned Physicians about hireing ill equipped staff {Billers) to reduce their overhead.

                It is true..anyone can data enter claims...but not just anyone can handle Medical Accounts Receivable. There is a big difference. To sum it up..arm yourself with all of the tools you can. Attend seminars and update constantly.

                Best of Luck to you!

                Jo An
              Your message has been successfully submitted and would be delivered to recipients shortly.