Download the .mp3 audio file here.
Our guest was Deb Winsor of W-Tech Solutions. Deb has a bachelor's degree in business administration from the University of Nebraska-Lincoln. She worked in a hospital setting for more than five years before joining an extremely well-known insurance company here in Omaha (whose name we won't mention) where she has worked for the past 11 years. Deb has experience with Medicare, Medicaid, managed Medicaid, PPO insurance, Tricare, and numerous other health insurance companies. Her company, W-Tech Solutions, provides billing services to mental health therapists.
Questions asked included:
- Question: "I billed a claim in error for Jane Smith and I should have billed the claim for her daughter Mary Smith. Do I send in a new claim for Mary? How can the insurance company help me with this error on my part?"
Deb's answer: When in doubt, call the insurance company and ask how they'd like it handled. Some insurance companies have the capability of "moving money" from one member of the family to another family. If the insurance company cannot or will not do this for you, ask if you should refund the money for Jane Smith and then bill a new, clean claim for Mary. The better you follow the instructions for that insurance company, the faster your error will be resolved.
- Question: Is it important to fill out box 10 a.b.c. on the 1500 form? Could you answer this questions -- and what is box 10?
Deb's answer: Box 10 relates to information that may affect the payment of the claim by this insurance carrier.
Box 10a: Select Yes to check if the patient's condition is related to employment. [This alerts the insurance company if this claim may be related to a Workmen's Compensation claim.]
Box 10b: Select Yes to check if the condition is related to an auto accident and enter the state. [This alerts the insurance company if this claim may be related to a car accident.]
Box 10c: Select Yes to check if the patient's condition is related to another accident.
The insurance company may return your claim for this information. This, in turn, holds up your payment. The better you fill out the 1500, the easier it is for the insurance company to process your claim. A claim with no errors is called a clean claim. Clean claims mean faster reimbursement for you.
If you use an accident-related code, you need to make sure it's not related to any other type of claim (Workmen's Compensation or automobile accident).
- Question: "My client has Medicaid. Is there a way to verify his benefits?"
Deb's answer: Medicaid is a payor of last resort. Make sure there is no other insurance that might be primary to Medicaid. Then, verify Medicaid eligibility. You can verify Medicaid eligibility five ways:
- Ask to see the client's monthly Nebraska Medicaid Card or Nebraska Health Connection ID document. Make a copy for your records.
- Call the automated Nebraska Medicaid Eligibility System (NMES line). In Lincoln, call (402) 471-9580 or (800) 642-6092 outside Lincoln.
- Work with your electronic data interchange (EDI) clearinghouse to set up electronic Health Care Eligibility Benefit Inquiry.
- Access client eligibility through the Internet.
- Call the Medicaid Inquiry Line at (877) 255-3092 or (402) 471-9128. You can find more information on the state's website.
You can use the NMES line to look at authorized sessions -- but make sure you do it well before the expiration date.
- Question: "All the information needed to process the claim is on the bill I give to my client. Do I have to submit my charges on an insurance claim form?"
Deb's answer: The easiest answer is a question. How quickly do you want to get paid? You could submit your charges on a nice letterhead statement. The insurance company might accept it. But they might not. And if they don't, your pretty piece of paper will be returned to you with questions from the insurance company. Or worse. If you are a contracted provider for the insurance company, your contract may state that you must bill on a HCFA 1500 form. In that case, you won't get paid without one.
The easier you make it for the insurance company to process your claim -- i.e., with correct spellings of names, correct demographic information, and most importantly, correct insurance information with proper authorizations, the faster you will get reimbursement.
- Question: "What are some of the most common reasons claims are denied?"
Deb's answer: A common reason is that there is no tax identification number, which makes it difficult to identify the therapist, especially if the provider has a common last name. You should be using a federal tax identification number instead of your personal social security number. Call the insurance company's Provider Relations number -- they can help you get this set up.
Bonus tip: Insurance companies can use three different types of codes for billing -- Revenue Ruling Codes, CPT Codes, and HCPCS codes. It pays to ask the insurance company which codes they use.
You can contact Deb at W-Tech Solutions at (402) 415-5338 or e-mail w-tech_billing@cox.net if you have any billing questions or if you're interested in working with her. W-Tech Solutions allows therapists to focus on the billing aspect of your business so you can focus on your clients.
This call was sponsored by W-Tech Solutions, Inc. and The Therapy Directory, powered by Psychology Today. Get a free 90-day trial of The Therapy Directory using this link.
The next Billing Questions Teleseminar will be Wednesday, July 14 from 3 to 3:45 p.m.
No comments:
Post a Comment