01 — CPT, HCPCS, ICD-10

Are you billing for every patient interaction? Providers are normally only aware that they can bill 4-6 codes and never stray outside of those codes. Insurance companies jobs are to verify benefits and pay claims that are coded properly. Insurance companies will never tell you how to bill or what you can bill. I can help you with this in more than one way. We can train staff on codes they can use, provide a short hand cheat sheet so providers can bill differently based on time and interaction. I can also provide email and phone support to individual situations.

02 — In-Network or Out of Network

Do you know that your notes can be audited for medical necessity as an out of network provider? Being in-network allows patients to use you at a discounted rate and provides you with a broader clientele base. However not all insurance companies pay remotely the same amount. Depending on a Clinician’s license the setting of the appointment, the state you are credentialed in and degree obtained your reimbursement rate can vary by 40%.

03 — Opt-out/ Accept Assignement

When you accept a Medicare patient and are a non-participating provider you can still accept the assignment of a patient. This is a box that must be checked on a CMS-1500 stating that you as the provider will agree to all Medicare guidelines for this patient and will not charge the patient more than 15% above what the assigned fee is. If you decided to accept a patient that has Medicare and do not want to accept assignment you must have them opt-out of assignment and you must opt out of all assignments on the CMS assignment CMAC website over your jurisdiction. Then and only then can you accept Medicare patients as cash pay and they will not be able to be reimbursed at any point through Medicare.

04 — EHR/EOBs/Rejections/Approvals

Many providers use their own therapy type billing software such as Simple Practice, Therapy Notes, Therapy Nest. These programs allow you to bill through them but often claims are lost, forgotten, partially paid, or rejected and no one understands or knows why. Fully integrating your billing system and ensuring you also have outside access to Change Health Care, Availity, Echo, Evernorth, Optum, and all others is a huge deal. You always want to follow up on claims that have not moved or updated in 14 days. Resubmitting, amending and voiding a claim must always reference the original claim number or they will be automatically rejected by the payor and Medicare claims must be amended or voided through your outside portal for re-consideration.