Physician Billing Podcast Episode 1 – How to Use Modifier 25
Mar10

Physician Billing Podcast Episode 1 – How to Use Modifier 25

Physician Billing Podcast Episode 1 – How to Use Modifier 25 Podcast: Play in new window | DownloadFind this article useful? Please comment below and share what you just found from this website! Go ahead - please click "SHARE"EmailTweetShare on...

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Medical Credentialing Services
Mar08

Medical Credentialing Services

Medical Credentialing Services You found this page perhaps because you are looking and searching about medical credentialing services. This post is about what this credentialing process can really do for your practice and why you must be careful in choosing the right people to help you. Most of my physicians who just got out of medical school and want to start a practice or join a group, they want to join an insurance network to become a participating provider. Now, what you will need a medical credentialing services consultant who can help you streamline the process and make it easier for you. As you might know, insurance contracting and credentialing is a very tedious work. You don’t want to go through that headache. Medical Credentialing Services Provider What you need to look for: They must have an extensive knowledge, experience and expertise on insurance contracting, negotiation and credentialing process;  Must be Familiar with the following: CAQH Council for Affordable Quality Healthcare (most Medical Credentialing Services company are familiar with CAQH) Medicare Enrollment Guidelines – PECOS or Paper Applications (Forms, Compliance and all related requirements for credentialing/enrollment) Liability Insurance Coverage (Professional/Individual and Facility/Group) National Provider Identification Guidelines (Individual and Organization) Different Insurance Payers’ Products (some physicians may join only the PPO part of the contract but not the HMO) Fee Schedule Analysis (I always tell my physician – “don’t sign the contract if you don’t agree with the fee schedule being offered to you by the payer”). Always compare your fees to Medicare’s fees where you can find them from your local Medicare’s website. The truth is because most of the time unfortunately, fee schedule are revealed to you based on the contract. If the physician don’t sign the contract, then there will be no contract done. An effective medical credentialing services provider is then able to negotiate the fees. Must be resourceful and knows how to handle communication with the Provider Services especially with the Contract Representative in the Area Submit to a weekly update on the status of the credentialing process What you need to be familiar before you hire your Medical Credentialing Services Company: Medicare Provider Enrollment: You can submit through PECOS (Provider Enrollment, Chain, and Ownership System (PECOS)) ; https://pecos.cms.hhs.gov/pecos/login.do#headingLv1 Or Submit Paper Application Forms;CMS-855B – Clinics/Group Practices and Certain Other Suppliers Clinics and group practices can apply for enrollment in the Medicare program or make a change to their existing enrollment information using the CMS-855B. Complete this application if you are an organization/group that plans to bill Medicare and you are: A medical practice or clinic that will bill for Medicare Part B services (e.g., group practices, clinics, independent...

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CAQH Credentialing Provider Database
Mar08

CAQH Credentialing Provider Database

CAQH Credentialing Provider Database Most of the insurance companies are now utilizing the CAQH credentialing provider database system when credentialing for physicians. This helps eliminate the paper application forms because the information needed for the credentialing for physicians required are now available on the website database. Allow yourself at least 2-3 hours to populate your information on CAQH credentialing provider database. Isn’t it nice that no more snail-mailing of credentialing application packets saving countless of trees. What CAQH Credentialing Provider database does is that, it captures all demographic information of the provider to ease the credentialing process and in fact, it becomes faster and more efficient way. I am guessing, it may save it may save the provider at least 3-4 weeks of processing time for the insurance credentialing process. This is just based on my 10 years of experience doing credentialing for physicians. I know that it may take approximately 2 to 3 hours to complete and enter all your demographic information on CAQH. So make sure you have everything ready, relax and have more than enough time when entering your data on CAQH Credentialing Provider database. Getting Started with CAQH Credentialing Provider Database You can also upload your all other related documents such as your professional liability insurance and copies your license and certifications. After you are finished, you have to perform attestation. And if there is a problem, CAQH will let notify you if there is a need for you to provide additional information or there are missing information. They will also notify you if one of your documents is expired. They will then provide you with how to fax them the missing information (such as a copy of an updated professional liability insurance). CAQH credentialing Provider database system is a non-profit organization and they have a website that providers and insurance payers get information. You can authorize the insurance company to look up your information on CAQH. Personal Information Educational Background Practice Information Upload Documents (Licenses, Liability Insurance and other related documents) Instead of you submitting application forms, they can look you up and all your related credentials, practice location addresses and your specialty and sub specialty. You can authorize all insurance companies to view your data on CAQH or you can choose which insurance companies will you allow. Do you need help with your credentialing? .. please contact me. I can help you. I have more than 10 years of credentialing experience. As you know, credentialing can be very tedious work. I can be available to help you in the process of getting credentialed. Read my clients’ testimonials about me and the praises I humbly had always received Find this article useful?...

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Medical Billing DME | DMEPOS EXEMPTIONS for Accreditation and Surety | For Physicians, Non-Physicians, Physical Therapist and Occupational Therapists
Aug20

Medical Billing DME | DMEPOS EXEMPTIONS for Accreditation and Surety | For Physicians, Non-Physicians, Physical Therapist and Occupational Therapists

Medical Billing DME I publish this article on my blog because many had been asking me for an answer – “Who are exempted from the DMEPOS from accreditation and/or surety bond?” for medical billing DME This article will focus only on Physicians/Non-Physician Practitioners and PT/OT Services Providers: According to the current guideline, the following are exempted: 1. Physicians 2. Physician Assistants 3. CRNA 4. Registered Nutritionists and Dieticians 5. Certified Midwife 6. Clinicial Social Worker 7. Clinical Psychologist **** But you need to be guided that items are provided and rendered to your own patients as a part of your own services! The Occupational and Physical Therapists are also Exempted from the accreditation process and surety bond only if …. 1. The PT/OT solely own and operates the business office; 2. You provide and rendered the items/services only to your own patients as part of professional services rendered; 3. You can only bill for orthotics, prosthetics and supplies. Additionally, I know that CHIROPRACTORS are NOT exempted from accreditation. Kindly see chart below which I have uploaded from =>> http://www.palmettogba.com/ncs and is last updated August 2009. As far as I know, there are no new changes on this guideline. Should you need help on how to complete a CMS-855s DMEPOS Form for your practice, contact me and I will help you. Read more about the Surety Bond Exemptions here – http://edocket.access.gpo.gov/2009/pdf/E8-30802.pdf Read more about the Accreditation Requirements here – http://www.cms.hhs.gov/MedicareProviderSupEnroll/Do wnloads/DMEPOSAccreditationMIPPA-FactSheet.pdf CMS Form for DMEPOS CMS-855S – Download here! CMS 855s Form for DMEPOS Supplier Application for Medicare   Useful References for DME Billing DME POS PLACE OF SERVICE CODES – https://med.noridianmedicare.com/web/jadme/claims-appeals/claim-submission/pos DMEPOS FEE SCHEDULE – https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/DMEPOSFeeSched/DMEPOS-Fee-Schedule.html Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Supplier Standards – (please copy and paste the link) http://www.palmettogba.com/palmetto/providers.nsf/DocsCat/Providers~National%20Supplier%20Clearinghouse~Supplier%20Enrollment~Standards%20Compliance~DMEPOS%20Supplier%20Standards~7GLS7Z1267 Medicare Enrollment Form for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers – (please copy and paste the link) – https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/cms855s.pdf Medicare Durable Equipment Claims Processing Manual http://www.mspinkymaniri.com/wp-content/uploads/2016/03/Chapter-20-Durable-Medical-Equipment-DMEPOS-Medicare-Claims-Processing-Manual-Rev-3196-02-13-15.pdf If you would like to know on how you can increase revenue in your practice by becoming a DME Medicare Supplier based on the necessity shown above and as long as you provide them as a part of your patients services, CALL ME and I will show you how. Interesting read, CLICK HERE — Why Physicians Medical Practice Cannot Make More Money   Need Immediate Help?  CHAT WITH US/TEXT/CALL  (888) 822-0862 Email: pinky.maniri@gmail.com We Offer CONSULTING SERVICES  We always OVER-DELIVER! 100% Satisfaction Guaranteed. Or we will return your money! We offer hourly coding consulting time on certain specialty only: Pain Management General Surgery Anesthesiology Physical Medicine and Rehabilitation Dermatology Obesity Medicine Sports Medicine Neurology Spine and Orthopedic Surgery Physical...

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