Insurance Billing manual updates

Insurance Billing manual updates:

There will be a new billing form in April 2007- The CMS 1500 form that is quite similar to the HCFA 1500 but with a few small changes one being a box for your National Provider Number.

Starting May 2007 if you are billing insurance companies you will need a National Provider number.

I have also added quite a lot of information on the legalities of doing business with third party payers on the blog after taking a seminar from two attorneys that were hired by AMTA-WA to help us here in WA State with our provider contracts.

The main points were:

If you are billing a higher rate to the insurance companies than you are your cash clients you are committing insurance fraud. You can try to explain it any way you want - you are doing medical massage, it requires more paperwork and time, it takes longer to pay, everyone else is doing it, I have a cash discount -whatever it is- you STILL have to PROVE IT in a court of law if ever questioned. Do you feel comfortable knowing that and knowing what your reason is? Insurance Fraud is punishable by 5 years in prison and $5000 per occurrence. Is it worth that risk?
- You can charge an extra fee in the amount that you would or do pay a billing service to do the billing which is usually 10-15% of your bill.

If you are working for a chiropractors office or other health care provider and are hired as a subcontractor it is illegal for the chiropractor to pay you a percentage of the amount charged as it is considered a kickback. The best way is to pay a flat rate as rent. If you are paid as an employee, it is ok to be paid a percentage.

Be sure to read any contract that you sign very carefully and understand all of the terms because you are required to comply with them.

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