RE: various issues: learning billing, EOB grooming, and income

[Guest guest]

From Dr Joanne in Drain, Oregon, The reason you haven't heard much from me recently is that I am now starting to do my own billing. I had a billing expert who came in 10 hours a week to bill for me, but I was seeing more patients, documenting the way she told me to, and not getting more money. So I decided to bite the bullet and learn Lytec well enough to bill for myself and find out why. As of two weeks ago, I have been billing the day's patients the end of every day, and am starting to cream through my old EOBs and do all the challanges, rebills, charging to secondary billing, etc,etc that one must do to actually collect what you are allowed to get from these folks. It is irritating and time consuming, but it certainly is making me a better coder as well as collecting a reasonable amount of money.

What was happening with my (everyone says including the MD she is working full time for) skilled billing person, is that she was skipping the tough ones: For example, Blue Cross Blue Shield 65 Plus is supposed to have a primary care provider that they have to access first. Some of them can come here for very acute problems if they can't get into their primary provider. They may be rejected for payment: however; if so, one can rebill straight to Medicare and get them (mostly) covered, except for 15 or 16 dollars. I found 25 or 30 of those that never got rebilled to Medicare. No, I didn't fire the part time worker. I have a rule that "you can never hire anyone to do anything you don't all ready know how to do yourself, better." I think it was my fault for not learning the system myself first. And the worker is doing a much better job now, too. I think the business was just getting too busy for one part timer, and I am not willing to hire someone full time for this; I refuse to become anything but a low overhead practice. Thinking about a second way increase income. I have been here in Drain long enough that I seem reliable to the local businesses for on-the-job injuries. Workman's comp pays like a trooper, if you keep good documentation. I am starting to become the one they send these folks to, and I have started to visit the local factories/businesses to offer my services. Businesses tend to have habits of behavior for injuries, and if you are their first choice, you can get some good cases, with great followup coverage. Here, these businesses are mills and machinist shops, with some logging companies, which have rather specific types of injury. Joanne

Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

From Dr Joanne in Drain, Oregon, The reason you haven't heard much from me recently is that I am now starting to do my own billing. I had a billing expert who came in 10 hours a week to bill for me, but I was seeing more patients, documenting the way she told me to, and not getting more money. So I decided to bite the bullet and learn Lytec well enough to bill for myself and find out why. As of two weeks ago, I have been billing the day's patients the end of every day, and am starting to cream through my old EOBs and do all the challanges, rebills, charging to secondary billing, etc,etc that one must do to actually collect what you are allowed to get from these folks. It is irritating and time consuming, but it certainly is making me a better coder as well as collecting a reasonable amount of money.

What was happening with my (everyone says including the MD she is working full time for) skilled billing person, is that she was skipping the tough ones: For example, Blue Cross Blue Shield 65 Plus is supposed to have a primary care provider that they have to access first. Some of them can come here for very acute problems if they can't get into their primary provider. They may be rejected for payment: however; if so, one can rebill straight to Medicare and get them (mostly) covered, except for 15 or 16 dollars. I found 25 or 30 of those that never got rebilled to Medicare. No, I didn't fire the part time worker. I have a rule that "you can never hire anyone to do anything you don't all ready know how to do yourself, better." I think it was my fault for not learning the system myself first. And the worker is doing a much better job now, too. I think the business was just getting too busy for one part timer, and I am not willing to hire someone full time for this; I refuse to become anything but a low overhead practice. Thinking about a second way increase income. I have been here in Drain long enough that I seem reliable to the local businesses for on-the-job injuries. Workman's comp pays like a trooper, if you keep good documentation. I am starting to become the one they send these folks to, and I have started to visit the local factories/businesses to offer my services. Businesses tend to have habits of behavior for injuries, and if you are their first choice, you can get some good cases, with great followup coverage. Here, these businesses are mills and machinist shops, with some logging companies, which have rather specific types of injury. Joanne

Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

Now that you are doing your own billing, how much time do you have

to devote to it daily? How much time on the phone etc. How much

time posting back to EOB's? Could you just give me a good estimate

per 25 encounters.

Thanks,

Brent

>

> From Dr Joanne in Drain, Oregon,

>

> The reason you haven't heard much from me recently is that I

am now starting to do my own billing. I had a billing expert who

came in 10 hours a week to bill for me, but I was seeing more

patients, documenting the way she told me to, and not getting more

money. So I decided to bite the bullet and learn Lytec well enough

to bill for myself and find out why.

> As of two weeks ago, I have been billing the day's patients

the end of every day, and am starting to cream through my old EOBs

and do all the challanges, rebills, charging to secondary billing,

etc,etc that one must do to actually collect what you are allowed to

get from these folks. It is irritating and time consuming, but it

certainly is making me a better coder as well as collecting a

reasonable amount of money.

> What was happening with my (everyone says including the MD

she is working full time for) skilled billing person, is that she

was skipping the tough ones: For example, Blue Cross Blue Shield 65

Plus is supposed to have a primary care provider that they have to

access first. Some of them can come here for very acute problems if

they can't get into their primary provider. They may be rejected

for payment: however; if so, one can rebill straight to Medicare

and get them (mostly) covered, except for 15 or 16 dollars. I found

25 or 30 of those that never got rebilled to Medicare.

> No, I didn't fire the part time worker. I have a rule

that " you can never hire anyone to do anything you don't all ready

know how to do yourself, better. " I think it was my fault for not

learning the system myself first. And the worker is doing a much

better job now, too.

> I think the business was just getting too busy for one part

timer, and I am not willing to hire someone full time for this; I

refuse to become anything but a low overhead practice.

>

> Thinking about a second way increase income. I have been here

in Drain long enough that I seem reliable to the local businesses

for on-the-job injuries. Workman's comp pays like a trooper, if you

keep good documentation. I am starting to become the one they send

these folks to, and I have started to visit the local

factories/businesses to offer my services. Businesses tend to have

habits of behavior for injuries, and if you are their first choice,

you can get some good cases, with great followup coverage. Here,

these businesses are mills and machinist shops, with some logging

companies, which have rather specific types of injury.

>

> Joanne

>

>

> ---------------------------------

> Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries for

just 2¢/min with Yahoo! Messenger with Voice.

>

[Guest guest]

Now that you are doing your own billing, how much time do you have

to devote to it daily? How much time on the phone etc. How much

time posting back to EOB's? Could you just give me a good estimate

per 25 encounters.

Thanks,

Brent

>

> From Dr Joanne in Drain, Oregon,

>

> The reason you haven't heard much from me recently is that I

am now starting to do my own billing. I had a billing expert who

came in 10 hours a week to bill for me, but I was seeing more

patients, documenting the way she told me to, and not getting more

money. So I decided to bite the bullet and learn Lytec well enough

to bill for myself and find out why.

> As of two weeks ago, I have been billing the day's patients

the end of every day, and am starting to cream through my old EOBs

and do all the challanges, rebills, charging to secondary billing,

etc,etc that one must do to actually collect what you are allowed to

get from these folks. It is irritating and time consuming, but it

certainly is making me a better coder as well as collecting a

reasonable amount of money.

> What was happening with my (everyone says including the MD

she is working full time for) skilled billing person, is that she

was skipping the tough ones: For example, Blue Cross Blue Shield 65

Plus is supposed to have a primary care provider that they have to

access first. Some of them can come here for very acute problems if

they can't get into their primary provider. They may be rejected

for payment: however; if so, one can rebill straight to Medicare

and get them (mostly) covered, except for 15 or 16 dollars. I found

25 or 30 of those that never got rebilled to Medicare.

> No, I didn't fire the part time worker. I have a rule

that " you can never hire anyone to do anything you don't all ready

know how to do yourself, better. " I think it was my fault for not

learning the system myself first. And the worker is doing a much

better job now, too.

> I think the business was just getting too busy for one part

timer, and I am not willing to hire someone full time for this; I

refuse to become anything but a low overhead practice.

>

> Thinking about a second way increase income. I have been here

in Drain long enough that I seem reliable to the local businesses

for on-the-job injuries. Workman's comp pays like a trooper, if you

keep good documentation. I am starting to become the one they send

these folks to, and I have started to visit the local

factories/businesses to offer my services. Businesses tend to have

habits of behavior for injuries, and if you are their first choice,

you can get some good cases, with great followup coverage. Here,

these businesses are mills and machinist shops, with some logging

companies, which have rather specific types of injury.

>

> Joanne

>

>

> ---------------------------------

> Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries for

just 2¢/min with Yahoo! Messenger with Voice.

>

[Guest guest]

HI Joanne in Drain,

Congrats on your expanding skills.  It really is eye-opening to dig into “working

the claims”

One thing that stood out to me, however,

was your statement that WC “pays like a trooper”.   I hope

that continues to be true for you, but for me, WC is a nightmare.   About half the time they never pay at all,

and take a year or more to ever actually deny, so by

then it’s too late to try the regular health insurance.  When they do pay, (after 90 days usually), they

pay thru subcontracts to really rotten payers like FirstHealth

or BeechStreet, and pay about 60% of what I would get

from most private insurances.   Two or three times over the past 4 years I

have gotten 100% of charges, and I guess that is what has kept me trying, but

not anymore.  I have just put in place a

policy requiring pay up front from the patients if they want me to see them for

WC or auto insurance related problems. 

Auto insurance also has occasionally paid 100%, but much more often, by

the time they go to the ER, that uses up all the available

benefit, so when I see them for the f/u, I get nothing.

On a cheerier note, I learned from the practicmgt listserv some tricks like billing preventive

plus OV on the same DOS with -25 on the OV for chronic disease mgt, and that

has almost doubled my reimbursement for visits where I was giving “one-stop-shopping”

and providing complete preventive service PLUS all

their chronic med refills and disease follow up testing, etc.  The only thing I don’t like about it is

that I have to write two completely different notes for the one visit, but good

thing I do because a couple times they requested the records before they would

pay.   I also am getting some payments

for 99050, 99058 and now 99051.  Next I

am going to try the prolonged service codes.

Good luck with your business adventures!

Annie

Re:

various issues: learning billing, EOB grooming, and

income

From Dr Joanne in Drain, Oregon,

The reason you haven't heard much

from me recently is that I am now starting to do my own billing. I had a

billing expert who came in 10 hours a week to bill for me, but I was seeing

more patients, documenting the way she told me to, and not getting more

money. So I decided to bite the bullet and learn Lytec well enough to

bill for myself and find out why.

As of two weeks ago, I have

been billing the day's patients the end of every day, and am starting to cream

through my old EOBs and do all the challanges, rebills, charging

to secondary billing, etc,etc that one must do to actually collect what you

are allowed to get from these folks. It is irritating and time consuming,

but it certainly is making me a better coder as well as collecting a

reasonable amount of money.

What was happening with my

(everyone says including the MD she is working full time for) skilled billing

person, is that she was skipping the tough ones: For example, Blue Cross

Blue Shield 65 Plus is supposed to have a primary care provider that they have

to access first. Some of them can come here for very acute problems if they

can't get into their primary provider. They may be rejected for

payment: however; if so, one can rebill straight to Medicare

and get them (mostly) covered, except for 15 or 16 dollars. I found 25 or

30 of those that never got rebilled to Medicare.

No, I didn't fire the part time

worker. I have a rule that " you can never hire anyone to do anything

you don't all ready know how to do yourself, better. " I think it was

my fault for not learning the system myself first. And the worker is

doing a much better job now, too.

I think the business was just

getting too busy for one part timer, and I am not willing to hire someone full

time for this; I refuse to become anything but a low overhead practice.

Thinking about a second

way increase income. I have been here in Drain long enough that

I seem reliable to the local businesses for on-the-job injuries.

Workman's comp pays like a trooper, if you keep good documentation. I am

starting to become the one they send these folks to, and I have started to

visit the local factories/businesses to offer my services. Businesses tend

to have habits of behavior for injuries, and if you are their first choice, you

can get some good cases, with great followup coverage. Here, these

businesses are mills and machinist shops, with some logging companies,

which have rather specific types of injury.

Joanne

Love cheap thrills? Enjoy PC-to-Phone calls

to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

Good job with the billing improvements. But please, remind me, what are

99050, 99058 and now 99051 codes?

Thanks

Tim

> HI Joanne in Drain,

>

> Congrats on your expanding skills. It really is eye-opening to dig into

> “working the claims”

>

> One thing that stood out to me, however, was your statement that WC

> “pays like a trooper”. I hope that continues to be true for you, but

> for me, WC is a nightmare. About half the time they never pay at all,

> and take a year or more to ever actually deny, so by then it’s too late

> to try the regular health insurance. When they do pay, (after 90 days

> usually), they pay thru subcontracts to really rotten payers like

> FirstHealth or BeechStreet, and pay about 60% of what I would get from

> most private insurances. Two or three times over the past 4 years I

> have gotten 100% of charges, and I guess that is what has kept me

> trying, but not anymore. I have just put in place a policy requiring

> pay up front from the patients if they want me to see them for WC or

> auto insurance related problems. Auto insurance also has occasionally

> paid 100%, but much more often, by the time they go to the ER, that uses

> up all the available benefit, so when I see them for the f/u, I get

> nothing.

>

> On a cheerier note, I learned from the practicmgt listserv some tricks

> like billing preventive plus OV on the same DOS with -25 on the OV for

> chronic disease mgt, and that has almost doubled my reimbursement for

> visits where I was giving “one-stop-shopping” and providing complete

> preventive service PLUS all their chronic med refills and disease follow

> up testing, etc. The only thing I don’t like about it is that I have to

> write two completely different notes for the one visit, but good thing I

> do because a couple times they requested the records before they would

> pay. I also am getting some payments for 99050, 99058 and now 99051.

> Next I am going to try the prolonged service codes.

>

> Good luck with your business adventures!

> Annie

>

> Re: various issues: learning billing,

> EOB grooming, and income

>

> From Dr Joanne in Drain, Oregon,

>

> The reason you haven't heard much from me recently is that I am now

> starting to do my own billing. I had a billing expert who came in 10

> hours a week to bill for me, but I was seeing more patients, documenting

> the way she told me to, and not getting more money. So I decided to

> bite the bullet and learn Lytec well enough to bill for myself and find

> out why.

> As of two weeks ago, I have been billing the day's patients the end

> of every day, and am starting to cream through my old EOBs and do all

> the challanges, rebills, charging to secondary billing, etc,etc that one

> must do to actually collect what you are allowed to get from these

> folks. It is irritating and time consuming, but it certainly is making

> me a better coder as well as collecting a reasonable amount of money.

> What was happening with my (everyone says including the MD she is

> working full time for) skilled billing person, is that she was skipping

> the tough ones: For example, Blue Cross Blue Shield 65 Plus is supposed

> to have a primary care provider that they have to access first. Some of

> them can come here for very acute problems if they can't get into their

> primary provider. They may be rejected for payment: however; if so,

> one can rebill straight to Medicare and get them (mostly) covered,

> except for 15 or 16 dollars. I found 25 or 30 of those that never got

> rebilled to Medicare.

> No, I didn't fire the part time worker. I have a rule that " you can

> never hire anyone to do anything you don't all ready know how to do

> yourself, better. " I think it was my fault for not learning the system

> myself first. And the worker is doing a much better job now, too.

> I think the business was just getting too busy for one part timer,

> and I am not willing to hire someone full time for this; I refuse to

> become anything but a low overhead practice.

>

> Thinking about a second way increase income. I have been here in

> Drain long enough that I seem reliable to the local businesses for

> on-the-job injuries. Workman's comp pays like a trooper, if you keep

> good documentation. I am starting to become the one they send these

> folks to, and I have started to visit the local factories/businesses to

> offer my services. Businesses tend to have habits of behavior for

> injuries, and if you are their first choice, you can get some good

> cases, with great followup coverage. Here, these businesses are mills

> and machinist shops, with some logging companies, which have rather

> specific types of injury.

>

> Joanne

> _____

>

> Love cheap thrills? Enjoy PC-to-Phone calls

> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com

> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for just

> 2¢/min with Yahoo! Messenger with Voice.

>

[Guest guest]

99050 is for urgent

service outside posted hours.  I use it

if I have to open the office back up to see someone after closing or if I come

in on the weekend or a holiday.

99058 is for

emergency services in the office.  The

guidelines say for service requiring the physician to disrupt the schedule.  I define that as anything that pulls me away

from another patient or causes me not to be available for a scheduled

appointment.  The walk in Chest Pain is

the classic example.  I DON’T

use it if I happen to not have a scheduled appointment at the time of the walk

in, but if I have a 2:00 scheduled and CP walks

in at 1:55 and causes me to make the 2:00 wait til after EMS comes then I DO charge it.

99051 is a new code this year.  It is for “regularly scheduled (not

urgent) appointments on holidays or Sundays”  I didn’t know about it until March,

when some folks on Practicemgt said they went back

and billed it for patients seen on Jan 2nd and MLK day and

had been paid by at least some insurers. 

I then rebilled too, but haven’t got any

responses yet.  I will have to look back

to see if this code can also be used for evening appointments.  I sort of think I recall reading that it can

be.  For example, my posted hours are ‘til

4:30, but usually once or twice a month I end up running an evening

clinic for people who can’t get off work for their physical during the

day.  Seems to me that an additional

charge is appropriate for giving up dinner with my family to do pap smears

until 9pm, even though it isn’t “urgent”

Medicare doesn’t pay any of these,

and some insurances consider them noncovered.  I have posted my regular office hours are and

included notice that appointments at other times are subject to “an

administrative fee that may not be covered by your insurance”.  At first I posted an amount of $25, but now I

leave that off because I bill $55 to insurance, but if the patient has to pay

it I will take it down to $25.  My vet

charges $75 for the same service, so I don’t think $25 is unreasonable.

Annie

Re: various issues: learning billing,

> EOB grooming, and income

>

> From Dr Joanne in Drain, Oregon,

>

> The reason you haven't heard much from me recently

is that I am now

> starting to do my own billing. I had a billing expert who came in 10

> hours a week to bill for me, but I was seeing more patients, documenting

> the way she told me to, and not getting more money. So I decided to

> bite the bullet and learn Lytec well enough to bill for myself and find

> out why.

> As of two weeks ago, I have been billing the

day's patients the end

> of every day, and am starting to cream through my old EOBs and do all

> the challanges, rebills, charging to secondary billing, etc,etc that one

> must do to actually collect what you are allowed to get from these

> folks. It is irritating and time consuming, but it certainly is

making

> me a better coder as well as collecting a reasonable amount of money.

> What was happening with my (everyone says

including the MD she is

> working full time for) skilled billing person, is that she was skipping

> the tough ones: For example, Blue Cross Blue Shield 65 Plus is

supposed

> to have a primary care provider that they have to access first. Some

of

> them can come here for very acute problems if they can't get into their

> primary provider. They may be rejected for payment:

however; if so,

> one can rebill straight to Medicare and get them (mostly) covered,

> except for 15 or 16 dollars. I found 25 or 30 of those that never

got

> rebilled to Medicare.

> No, I didn't fire the part time worker. I

have a rule that " you can

> never hire anyone to do anything you don't all ready know how to do

> yourself, better. " I think it was my fault for not learning the

system

> myself first. And the worker is doing a much better job now, too.

> I think the business was just getting too busy for

one part timer,

> and I am not willing to hire someone full time for this; I refuse to

> become anything but a low overhead practice.

>

> Thinking about a second way increase income. I have been

here in

> Drain long enough that I seem reliable to the local businesses for

> on-the-job injuries. Workman's comp pays like a trooper, if you keep

> good documentation. I am starting to become the one they send these

> folks to, and I have started to visit the local factories/businesses to

> offer my services. Businesses tend to have habits of behavior for

> injuries, and if you are their first choice, you can get some good

> cases, with great followup coverage. Here, these businesses are

mills

> and machinist shops, with some logging companies, which have rather

> specific types of injury.

>

>

Joanne

> _____

>

> Love cheap thrills? Enjoy PC-to-Phone calls

> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com

> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for

just

> 2¢/min with Yahoo! Messenger with Voice.

>

[Guest guest]

99050 is for urgent

service outside posted hours.  I use it

if I have to open the office back up to see someone after closing or if I come

in on the weekend or a holiday.

99058 is for

emergency services in the office.  The

guidelines say for service requiring the physician to disrupt the schedule.  I define that as anything that pulls me away

from another patient or causes me not to be available for a scheduled

appointment.  The walk in Chest Pain is

the classic example.  I DON’T

use it if I happen to not have a scheduled appointment at the time of the walk

in, but if I have a 2:00 scheduled and CP walks

in at 1:55 and causes me to make the 2:00 wait til after EMS comes then I DO charge it.

99051 is a new code this year.  It is for “regularly scheduled (not

urgent) appointments on holidays or Sundays”  I didn’t know about it until March,

when some folks on Practicemgt said they went back

and billed it for patients seen on Jan 2nd and MLK day and

had been paid by at least some insurers. 

I then rebilled too, but haven’t got any

responses yet.  I will have to look back

to see if this code can also be used for evening appointments.  I sort of think I recall reading that it can

be.  For example, my posted hours are ‘til

4:30, but usually once or twice a month I end up running an evening

clinic for people who can’t get off work for their physical during the

day.  Seems to me that an additional

charge is appropriate for giving up dinner with my family to do pap smears

until 9pm, even though it isn’t “urgent”

Medicare doesn’t pay any of these,

and some insurances consider them noncovered.  I have posted my regular office hours are and

included notice that appointments at other times are subject to “an

administrative fee that may not be covered by your insurance”.  At first I posted an amount of $25, but now I

leave that off because I bill $55 to insurance, but if the patient has to pay

it I will take it down to $25.  My vet

charges $75 for the same service, so I don’t think $25 is unreasonable.

Annie

Re: various issues: learning billing,

> EOB grooming, and income

>

> From Dr Joanne in Drain, Oregon,

>

> The reason you haven't heard much from me recently

is that I am now

> starting to do my own billing. I had a billing expert who came in 10

> hours a week to bill for me, but I was seeing more patients, documenting

> the way she told me to, and not getting more money. So I decided to

> bite the bullet and learn Lytec well enough to bill for myself and find

> out why.

> As of two weeks ago, I have been billing the

day's patients the end

> of every day, and am starting to cream through my old EOBs and do all

> the challanges, rebills, charging to secondary billing, etc,etc that one

> must do to actually collect what you are allowed to get from these

> folks. It is irritating and time consuming, but it certainly is

making

> me a better coder as well as collecting a reasonable amount of money.

> What was happening with my (everyone says

including the MD she is

> working full time for) skilled billing person, is that she was skipping

> the tough ones: For example, Blue Cross Blue Shield 65 Plus is

supposed

> to have a primary care provider that they have to access first. Some

of

> them can come here for very acute problems if they can't get into their

> primary provider. They may be rejected for payment:

however; if so,

> one can rebill straight to Medicare and get them (mostly) covered,

> except for 15 or 16 dollars. I found 25 or 30 of those that never

got

> rebilled to Medicare.

> No, I didn't fire the part time worker. I

have a rule that " you can

> never hire anyone to do anything you don't all ready know how to do

> yourself, better. " I think it was my fault for not learning the

system

> myself first. And the worker is doing a much better job now, too.

> I think the business was just getting too busy for

one part timer,

> and I am not willing to hire someone full time for this; I refuse to

> become anything but a low overhead practice.

>

> Thinking about a second way increase income. I have been

here in

> Drain long enough that I seem reliable to the local businesses for

> on-the-job injuries. Workman's comp pays like a trooper, if you keep

> good documentation. I am starting to become the one they send these

> folks to, and I have started to visit the local factories/businesses to

> offer my services. Businesses tend to have habits of behavior for

> injuries, and if you are their first choice, you can get some good

> cases, with great followup coverage. Here, these businesses are

mills

> and machinist shops, with some logging companies, which have rather

> specific types of injury.

>

>

Joanne

> _____

>

> Love cheap thrills? Enjoy PC-to-Phone calls

> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com

> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for

just

> 2¢/min with Yahoo! Messenger with Voice.

>

[Guest guest]

Hi Annie,

I’ve had poor experience with

getting the preventative and chronic dz OV covered, even with 25 modifier. Most

insurances in my area just flat out won’t cover them on the same day.  I

have had good reimbursement for the prolonged services codes, however.

A. Eads, M.D.

Pinnacle Family Medicine, PLLC

phone fax

P.O.

Box 7275

Woodland

Park, CO 80863

From: [mailto: ] On Behalf Of Annie Skaggs

Sent: Sunday, April 23, 2006 6:29

AM

To:

Subject: RE:

various issues: learning billing, EOB grooming, and

income

HI Joanne in Drain,

Congrats on your expanding skills.  It

really is eye-opening to dig into “working the claims”

One thing that stood out to me, however,

was your statement that WC “pays like a trooper”.   I hope that

continues to be true for you, but for me, WC is a nightmare.   About half the

time they never pay at all, and take a year or more to ever actually deny, so

by then it’s too late to try the regular health insurance.  When they do

pay, (after 90 days usually), they pay thru subcontracts to really rotten

payers like FirstHealth or BeechStreet, and pay about 60% of what I would get

from most private insurances.   Two or three times over the past 4 years I have

gotten 100% of charges, and I guess that is what has kept me trying, but not

anymore.  I have just put in place a policy requiring pay up front from the

patients if they want me to see them for WC or auto insurance related

problems.  Auto insurance also has occasionally paid 100%, but much more often,

by the time they go to the ER, that uses up all the available benefit, so when

I see them for the f/u, I get nothing.

On a cheerier note, I learned from the

practicmgt listserv some tricks like billing preventive plus OV on the same DOS

with -25 on the OV for chronic disease mgt, and that has almost doubled my

reimbursement for visits where I was giving “one-stop-shopping” and

providing complete preventive service PLUS

all their chronic med refills and disease follow up testing, etc.  The only

thing I don’t like about it is that I have to write two completely

different notes for the one visit, but good thing I do because a couple times

they requested the records before they would pay.   I also am getting some

payments for 99050, 99058 and now 99051.  Next I am going to try the prolonged

service codes.

Good luck with your business adventures!

Annie

Re:

various issues: learning billing, EOB grooming, and income

From Dr Joanne in Drain, Oregon,

The reason you haven't heard much

from me recently is that I am now starting to do my own billing. I had a

billing expert who came in 10 hours a week to bill for me, but I was seeing

more patients, documenting the way she told me to, and not getting more

money. So I decided to bite the bullet and learn Lytec well enough to

bill for myself and find out why.

As of two weeks ago, I have

been billing the day's patients the end of every day, and am starting to cream

through my old EOBs and do all the challanges, rebills, charging

to secondary billing, etc,etc that one must do to actually collect what

you are allowed to get from these folks. It is irritating and time

consuming, but it certainly is making me a better coder as well as

collecting a reasonable amount of money.

What was happening with my

(everyone says including the MD she is working full time for) skilled billing

person, is that she was skipping the tough ones: For example, Blue Cross

Blue Shield 65 Plus is supposed to have a primary care provider that they have

to access first. Some of them can come here for very acute problems if

they can't get into their primary provider. They may be rejected for

payment: however; if so, one can rebill straight to Medicare

and get them (mostly) covered, except for 15 or 16 dollars. I found 25 or

30 of those that never got rebilled to Medicare.

No, I didn't fire the part time

worker. I have a rule that " you can never hire anyone to do anything

you don't all ready know how to do yourself, better. " I think it was

my fault for not learning the system myself first. And the worker is

doing a much better job now, too.

I think the business was just

getting too busy for one part timer, and I am not willing to hire someone full

time for this; I refuse to become anything but a low overhead practice.

Thinking about a second

way increase income. I have been here in Drain long enough that

I seem reliable to the local businesses for on-the-job injuries.

Workman's comp pays like a trooper, if you keep good documentation. I am

starting to become the one they send these folks to, and I have started to

visit the local factories/businesses to offer my services. Businesses tend

to have habits of behavior for injuries, and if you are their first choice, you

can get some good cases, with great followup coverage. Here, these

businesses are mills and machinist shops, with some logging companies,

which have rather specific types of injury.

Joanne

Love cheap thrills? Enjoy PC-to-Phone calls

to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

Thanks... always worth a try...

Tim

> 99050 is for urgent service outside posted hours. I use it if I have to

> open the office back up to see someone after closing or if I come in on

> the weekend or a holiday.

> 99058 is for emergency services in the office. The guidelines say for

> service requiring the physician to disrupt the schedule. I define that

> as anything that pulls me away from another patient or causes me not to

> be available for a scheduled appointment. The walk in Chest Pain is the

> classic example. I DON’T use it if I happen to not have a scheduled

> appointment at the time of the walk in, but if I have a 2:00 scheduled

> and CP walks in at 1:55 and causes me to make the 2:00 wait til after

> EMS comes then I DO charge it.

> 99051 is a new code this year. It is for “regularly scheduled (not

> urgent) appointments on holidays or Sundays” I didn’t know about it

> until March, when some folks on Practicemgt said they went back and

> billed it for patients seen on Jan 2nd and MLK day and had been paid by

> at least some insurers. I then rebilled too, but haven’t got any

> responses yet. I will have to look back to see if this code can also be

> used for evening appointments. I sort of think I recall reading that it

> can be. For example, my posted hours are ‘til 4:30, but usually once or

> twice a month I end up running an evening clinic for people who can’t

> get off work for their physical during the day. Seems to me that an

> additional charge is appropriate for giving up dinner with my family to

> do pap smears until 9pm, even though it isn’t “urgent”

>

> Medicare doesn’t pay any of these, and some insurances consider them

> noncovered. I have posted my regular office hours are and included

> notice that appointments at other times are subject to “an

> administrative fee that may not be covered by your insurance”. At first

> I posted an amount of $25, but now I leave that off because I bill $55

> to insurance, but if the patient has to pay it I will take it down to

> $25. My vet charges $75 for the same service, so I don’t think $25 is

> unreasonable.

>

> Annie

>

> Re: various issues: learning billing,

>> EOB grooming, and income

>>

>> From Dr Joanne in Drain, Oregon,

>>

>> The reason you haven't heard much from me recently is that I am

> now

>> starting to do my own billing. I had a billing expert who came in 10

>> hours a week to bill for me, but I was seeing more patients,

> documenting

>> the way she told me to, and not getting more money. So I decided to

>> bite the bullet and learn Lytec well enough to bill for myself and

> find

>> out why.

>> As of two weeks ago, I have been billing the day's patients the

> end

>> of every day, and am starting to cream through my old EOBs and do all

>> the challanges, rebills, charging to secondary billing, etc,etc that

> one

>> must do to actually collect what you are allowed to get from these

>> folks. It is irritating and time consuming, but it certainly is

> making

>> me a better coder as well as collecting a reasonable amount of money.

>> What was happening with my (everyone says including the MD she is

>> working full time for) skilled billing person, is that she was

> skipping

>> the tough ones: For example, Blue Cross Blue Shield 65 Plus is

> supposed

>> to have a primary care provider that they have to access first. Some

> of

>> them can come here for very acute problems if they can't get into

> their

>> primary provider. They may be rejected for payment: however; if so,

>> one can rebill straight to Medicare and get them (mostly) covered,

>> except for 15 or 16 dollars. I found 25 or 30 of those that never got

>> rebilled to Medicare.

>> No, I didn't fire the part time worker. I have a rule that " you

> can

>> never hire anyone to do anything you don't all ready know how to do

>> yourself, better. " I think it was my fault for not learning the

> system

>> myself first. And the worker is doing a much better job now, too.

>> I think the business was just getting too busy for one part timer,

>> and I am not willing to hire someone full time for this; I refuse to

>> become anything but a low overhead practice.

>>

>> Thinking about a second way increase income. I have been here in

>> Drain long enough that I seem reliable to the local businesses for

>> on-the-job injuries. Workman's comp pays like a trooper, if you keep

>> good documentation. I am starting to become the one they send these

>> folks to, and I have started to visit the local factories/businesses

> to

>> offer my services. Businesses tend to have habits of behavior for

>> injuries, and if you are their first choice, you can get some good

>> cases, with great followup coverage. Here, these businesses are mills

>> and machinist shops, with some logging companies, which have rather

>> specific types of injury.

>>

>> Joanne

>> _____

>>

>> Love cheap thrills? Enjoy PC-to-Phone calls

>>

> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com

>> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for

> just

>> 2¢/min with Yahoo! Messenger with Voice.

>>

[Guest guest]

Thanks... always worth a try...

Tim

> 99050 is for urgent service outside posted hours. I use it if I have to

> open the office back up to see someone after closing or if I come in on

> the weekend or a holiday.

> 99058 is for emergency services in the office. The guidelines say for

> service requiring the physician to disrupt the schedule. I define that

> as anything that pulls me away from another patient or causes me not to

> be available for a scheduled appointment. The walk in Chest Pain is the

> classic example. I DON’T use it if I happen to not have a scheduled

> appointment at the time of the walk in, but if I have a 2:00 scheduled

> and CP walks in at 1:55 and causes me to make the 2:00 wait til after

> EMS comes then I DO charge it.

> 99051 is a new code this year. It is for “regularly scheduled (not

> urgent) appointments on holidays or Sundays” I didn’t know about it

> until March, when some folks on Practicemgt said they went back and

> billed it for patients seen on Jan 2nd and MLK day and had been paid by

> at least some insurers. I then rebilled too, but haven’t got any

> responses yet. I will have to look back to see if this code can also be

> used for evening appointments. I sort of think I recall reading that it

> can be. For example, my posted hours are ‘til 4:30, but usually once or

> twice a month I end up running an evening clinic for people who can’t

> get off work for their physical during the day. Seems to me that an

> additional charge is appropriate for giving up dinner with my family to

> do pap smears until 9pm, even though it isn’t “urgent”

>

> Medicare doesn’t pay any of these, and some insurances consider them

> noncovered. I have posted my regular office hours are and included

> notice that appointments at other times are subject to “an

> administrative fee that may not be covered by your insurance”. At first

> I posted an amount of $25, but now I leave that off because I bill $55

> to insurance, but if the patient has to pay it I will take it down to

> $25. My vet charges $75 for the same service, so I don’t think $25 is

> unreasonable.

>

> Annie

>

> Re: various issues: learning billing,

>> EOB grooming, and income

>>

>> From Dr Joanne in Drain, Oregon,

>>

>> The reason you haven't heard much from me recently is that I am

> now

>> starting to do my own billing. I had a billing expert who came in 10

>> hours a week to bill for me, but I was seeing more patients,

> documenting

>> the way she told me to, and not getting more money. So I decided to

>> bite the bullet and learn Lytec well enough to bill for myself and

> find

>> out why.

>> As of two weeks ago, I have been billing the day's patients the

> end

>> of every day, and am starting to cream through my old EOBs and do all

>> the challanges, rebills, charging to secondary billing, etc,etc that

> one

>> must do to actually collect what you are allowed to get from these

>> folks. It is irritating and time consuming, but it certainly is

> making

>> me a better coder as well as collecting a reasonable amount of money.

>> What was happening with my (everyone says including the MD she is

>> working full time for) skilled billing person, is that she was

> skipping

>> the tough ones: For example, Blue Cross Blue Shield 65 Plus is

> supposed

>> to have a primary care provider that they have to access first. Some

> of

>> them can come here for very acute problems if they can't get into

> their

>> primary provider. They may be rejected for payment: however; if so,

>> one can rebill straight to Medicare and get them (mostly) covered,

>> except for 15 or 16 dollars. I found 25 or 30 of those that never got

>> rebilled to Medicare.

>> No, I didn't fire the part time worker. I have a rule that " you

> can

>> never hire anyone to do anything you don't all ready know how to do

>> yourself, better. " I think it was my fault for not learning the

> system

>> myself first. And the worker is doing a much better job now, too.

>> I think the business was just getting too busy for one part timer,

>> and I am not willing to hire someone full time for this; I refuse to

>> become anything but a low overhead practice.

>>

>> Thinking about a second way increase income. I have been here in

>> Drain long enough that I seem reliable to the local businesses for

>> on-the-job injuries. Workman's comp pays like a trooper, if you keep

>> good documentation. I am starting to become the one they send these

>> folks to, and I have started to visit the local factories/businesses

> to

>> offer my services. Businesses tend to have habits of behavior for

>> injuries, and if you are their first choice, you can get some good

>> cases, with great followup coverage. Here, these businesses are mills

>> and machinist shops, with some logging companies, which have rather

>> specific types of injury.

>>

>> Joanne

>> _____

>>

>> Love cheap thrills? Enjoy PC-to-Phone calls

>>

> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com

>> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for

> just

>> 2¢/min with Yahoo! Messenger with Voice.

>>

[Guest guest]

It has been interesting to try.  I didn’t try at first with Anthem because

others told me they wouldn’t pay, but last month I went ahead and tried

because all my other payers are doing it.  Even Medicare will pay a 99214-25 on the same

day as the G0344 (welcome to MCR physical plus G0366, EKG in that context).  And once I tried Anthem, they have paid a

couple so far.  They asked for copies of

the notes, but then they paid up….makes it worth the pain of writing two

notes.

Annie

Re:

various issues: learning billing, EOB grooming, and

income

From Dr Joanne in Drain, Oregon,

The reason you haven't heard much

from me recently is that I am now starting to do my own billing. I had a

billing expert who came in 10 hours a week to bill for me, but I was seeing

more patients, documenting the way she told me to, and not getting more

money. So I decided to bite the bullet and learn Lytec well enough to

bill for myself and find out why.

As of two weeks ago, I have

been billing the day's patients the end of every day, and am starting to cream

through my old EOBs and do all the challanges, rebills, charging

to secondary billing, etc,etc that one must do to actually collect what

you are allowed to get from these folks. It is irritating and time

consuming, but it certainly is making me a better coder as well as

collecting a reasonable amount of money.

What was happening with my (everyone

says including the MD she is working full time for) skilled billing person, is

that she was skipping the tough ones: For example, Blue Cross Blue Shield

65 Plus is supposed to have a primary care provider that they have to access

first. Some of them can come here for very acute problems if they can't

get into their primary provider. They may be rejected for payment:

however; if so, one can rebill straight to Medicare and get

them (mostly) covered, except for 15 or 16 dollars. I found 25 or 30 of

those that never got rebilled to Medicare.

No, I didn't fire the part time

worker. I have a rule that " you can never hire anyone to do anything

you don't all ready know how to do yourself, better. " I think it was

my fault for not learning the system myself first. And the worker is

doing a much better job now, too.

I think the business was just

getting too busy for one part timer, and I am not willing to hire someone full

time for this; I refuse to become anything but a low overhead practice.

Thinking about a second

way increase income. I have been here in Drain long enough that

I seem reliable to the local businesses for on-the-job injuries.

Workman's comp pays like a trooper, if you keep good documentation. I am

starting to become the one they send these folks to, and I have started to

visit the local factories/businesses to offer my services. Businesses tend

to have habits of behavior for injuries, and if you are their first choice, you

can get some good cases, with great followup coverage. Here, these

businesses are mills and machinist shops, with some logging companies,

which have rather specific types of injury.

Joanne

Love cheap thrills? Enjoy PC-to-Phone calls

to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

It has been interesting to try.  I didn’t try at first with Anthem because

others told me they wouldn’t pay, but last month I went ahead and tried

because all my other payers are doing it.  Even Medicare will pay a 99214-25 on the same

day as the G0344 (welcome to MCR physical plus G0366, EKG in that context).  And once I tried Anthem, they have paid a

couple so far.  They asked for copies of

the notes, but then they paid up….makes it worth the pain of writing two

notes.

Annie

Re:

various issues: learning billing, EOB grooming, and

income

From Dr Joanne in Drain, Oregon,

The reason you haven't heard much

from me recently is that I am now starting to do my own billing. I had a

billing expert who came in 10 hours a week to bill for me, but I was seeing

more patients, documenting the way she told me to, and not getting more

money. So I decided to bite the bullet and learn Lytec well enough to

bill for myself and find out why.

As of two weeks ago, I have

been billing the day's patients the end of every day, and am starting to cream

through my old EOBs and do all the challanges, rebills, charging

to secondary billing, etc,etc that one must do to actually collect what

you are allowed to get from these folks. It is irritating and time

consuming, but it certainly is making me a better coder as well as

collecting a reasonable amount of money.

What was happening with my (everyone

says including the MD she is working full time for) skilled billing person, is

that she was skipping the tough ones: For example, Blue Cross Blue Shield

65 Plus is supposed to have a primary care provider that they have to access

first. Some of them can come here for very acute problems if they can't

get into their primary provider. They may be rejected for payment:

however; if so, one can rebill straight to Medicare and get

them (mostly) covered, except for 15 or 16 dollars. I found 25 or 30 of

those that never got rebilled to Medicare.

No, I didn't fire the part time

worker. I have a rule that " you can never hire anyone to do anything

you don't all ready know how to do yourself, better. " I think it was

my fault for not learning the system myself first. And the worker is

doing a much better job now, too.

I think the business was just

getting too busy for one part timer, and I am not willing to hire someone full

time for this; I refuse to become anything but a low overhead practice.

Thinking about a second

way increase income. I have been here in Drain long enough that

I seem reliable to the local businesses for on-the-job injuries.

Workman's comp pays like a trooper, if you keep good documentation. I am

starting to become the one they send these folks to, and I have started to

visit the local factories/businesses to offer my services. Businesses tend

to have habits of behavior for injuries, and if you are their first choice, you

can get some good cases, with great followup coverage. Here, these

businesses are mills and machinist shops, with some logging companies,

which have rather specific types of injury.

Joanne

Love cheap thrills? Enjoy PC-to-Phone calls

to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

This is very area-specific and insurance-company specific. I am reimbursed by the majority of my payers for the combined preventive and disease-management coding with the 25 modifier. I'm also appealing each denial right now - and getting paid on some of those appeals. I've starting charting the visit in 2 separate blocks  in the HPI and assessment/plan just to underscore the two separate services.Hi Annie, I’ve had poor experience with getting the preventative and chronic dz OV covered, even with 25 modifier. Most insurances in my area just flat out won’t cover them on the same day.  I have had good reimbursement for the prolonged services codes, however.  A. Eads, M.D.Pinnacle Family Medicine, PLLC phone faxP.O. Box 7275Woodland Park, CO 80863From: [mailto: ] On Behalf Of Annie SkaggsSent: Sunday, April 23, 2006 6:29 AMTo: Subject: RE: various issues: learning billing, EOB grooming, and income HI Joanne in Drain, Congrats on your expanding skills.  It really is eye-opening to dig into “working the claims” One thing that stood out to me, however, was your statement that WC “pays like a trooper”.   I hope that continues to be true for you, but for me, WC is a nightmare.   About half the time they never pay at all, and take a year or more to ever actually deny, so by then it’s too late to try the regular health insurance.  When they do pay, (after 90 days usually), they pay thru subcontracts to really rotten payers like FirstHealth or BeechStreet, and pay about 60% of what I would get from most private insurances.   Two or three times over the past 4 years I have gotten 100% of charges, and I guess that is what has kept me trying, but not anymore.  I have just put in place a policy requiring pay up front from the patients if they want me to see them for WC or auto insurance related problems.  Auto insurance also has occasionally paid 100%, but much more often, by the time they go to the ER, that uses up all the available benefit, so when I see them for the f/u, I get nothing. On a cheerier note, I learned from the practicmgt listserv some tricks like billing preventive plus OV on the same DOS with -25 on the OV for chronic disease mgt, and that has almost doubled my reimbursement for visits where I was giving “one-stop-shopping” and providing complete preventive service PLUS all their chronic med refills and disease follow up testing, etc.  The only thing I don’t like about it is that I have to write two completely different notes for the one visit, but good thing I do because a couple times they requested the records before they would pay.   I also am getting some payments for 99050, 99058 and now 99051.  Next I am going to try the prolonged service codes. Good luck with your business adventures!Annie -----Original Message-----From: [mailto: ] On Behalf Of joanne hollandSent: Saturday, April 22, 2006 1:12 PMTo: Subject: Re: various issues: learning billing, EOB grooming, and income From Dr Joanne in Drain, Oregon,     The reason you haven't heard much from me recently is that I am now starting to do my own billing.  I had a billing expert who came in 10 hours a week to bill for me, but I was seeing more patients, documenting the way she told me to, and not getting more money.  So I decided to bite the bullet and learn Lytec well enough to bill for myself and find out why.      As of two weeks ago, I have been billing the day's patients the end of every day, and am starting to cream through my old EOBs and do all the challanges, rebills, charging to secondary billing, etc,etc that one must do to actually collect what you are allowed to get from these folks.  It is irritating and time consuming, but it certainly is making me a better coder as well as collecting a reasonable amount of money.     What was happening with my (everyone says including the MD she is working full time for) skilled billing person, is that she was skipping the tough ones:  For example, Blue Cross Blue Shield 65 Plus is supposed to have a primary care provider that they have to access first.  Some of them can come here for very acute problems if they can't get into their primary provider.  They may be rejected for payment: however;   if so, one can rebill straight to Medicare and get them (mostly) covered, except for 15 or 16 dollars.  I found 25 or 30 of those that never got rebilled to Medicare.     No, I didn't fire the part time worker.  I have a rule that "you can never hire anyone to do anything you don't all ready know how to do yourself, better."  I think it was my fault for not learning the system myself first.  And the worker is doing a much better job now, too.    I think the business was just getting too busy for one part timer, and I am not willing to hire someone full time for this; I refuse to become anything but a low overhead practice.    Thinking about a second way increase income. I have been here in Drain long enough that I seem reliable to the local businesses for on-the-job injuries.  Workman's comp pays like a trooper, if you keep good documentation.  I am starting to become the one they send these folks to, and I have started to visit the local factories/businesses to offer my services. Businesses tend to have habits of behavior for injuries, and if you are their first choice, you can get some good cases, with great followup coverage.  Here, these businesses are mills and machinist shops, with some logging companies, which have rather specific types of injury.                               JoanneLove cheap thrills? Enjoy PC-to-Phone calls to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

This is very area-specific and insurance-company specific. I am reimbursed by the majority of my payers for the combined preventive and disease-management coding with the 25 modifier. I'm also appealing each denial right now - and getting paid on some of those appeals. I've starting charting the visit in 2 separate blocks  in the HPI and assessment/plan just to underscore the two separate services.Hi Annie, I’ve had poor experience with getting the preventative and chronic dz OV covered, even with 25 modifier. Most insurances in my area just flat out won’t cover them on the same day.  I have had good reimbursement for the prolonged services codes, however.  A. Eads, M.D.Pinnacle Family Medicine, PLLC phone faxP.O. Box 7275Woodland Park, CO 80863From: [mailto: ] On Behalf Of Annie SkaggsSent: Sunday, April 23, 2006 6:29 AMTo: Subject: RE: various issues: learning billing, EOB grooming, and income HI Joanne in Drain, Congrats on your expanding skills.  It really is eye-opening to dig into “working the claims” One thing that stood out to me, however, was your statement that WC “pays like a trooper”.   I hope that continues to be true for you, but for me, WC is a nightmare.   About half the time they never pay at all, and take a year or more to ever actually deny, so by then it’s too late to try the regular health insurance.  When they do pay, (after 90 days usually), they pay thru subcontracts to really rotten payers like FirstHealth or BeechStreet, and pay about 60% of what I would get from most private insurances.   Two or three times over the past 4 years I have gotten 100% of charges, and I guess that is what has kept me trying, but not anymore.  I have just put in place a policy requiring pay up front from the patients if they want me to see them for WC or auto insurance related problems.  Auto insurance also has occasionally paid 100%, but much more often, by the time they go to the ER, that uses up all the available benefit, so when I see them for the f/u, I get nothing. On a cheerier note, I learned from the practicmgt listserv some tricks like billing preventive plus OV on the same DOS with -25 on the OV for chronic disease mgt, and that has almost doubled my reimbursement for visits where I was giving “one-stop-shopping” and providing complete preventive service PLUS all their chronic med refills and disease follow up testing, etc.  The only thing I don’t like about it is that I have to write two completely different notes for the one visit, but good thing I do because a couple times they requested the records before they would pay.   I also am getting some payments for 99050, 99058 and now 99051.  Next I am going to try the prolonged service codes. Good luck with your business adventures!Annie -----Original Message-----From: [mailto: ] On Behalf Of joanne hollandSent: Saturday, April 22, 2006 1:12 PMTo: Subject: Re: various issues: learning billing, EOB grooming, and income From Dr Joanne in Drain, Oregon,     The reason you haven't heard much from me recently is that I am now starting to do my own billing.  I had a billing expert who came in 10 hours a week to bill for me, but I was seeing more patients, documenting the way she told me to, and not getting more money.  So I decided to bite the bullet and learn Lytec well enough to bill for myself and find out why.      As of two weeks ago, I have been billing the day's patients the end of every day, and am starting to cream through my old EOBs and do all the challanges, rebills, charging to secondary billing, etc,etc that one must do to actually collect what you are allowed to get from these folks.  It is irritating and time consuming, but it certainly is making me a better coder as well as collecting a reasonable amount of money.     What was happening with my (everyone says including the MD she is working full time for) skilled billing person, is that she was skipping the tough ones:  For example, Blue Cross Blue Shield 65 Plus is supposed to have a primary care provider that they have to access first.  Some of them can come here for very acute problems if they can't get into their primary provider.  They may be rejected for payment: however;   if so, one can rebill straight to Medicare and get them (mostly) covered, except for 15 or 16 dollars.  I found 25 or 30 of those that never got rebilled to Medicare.     No, I didn't fire the part time worker.  I have a rule that "you can never hire anyone to do anything you don't all ready know how to do yourself, better."  I think it was my fault for not learning the system myself first.  And the worker is doing a much better job now, too.    I think the business was just getting too busy for one part timer, and I am not willing to hire someone full time for this; I refuse to become anything but a low overhead practice.    Thinking about a second way increase income. I have been here in Drain long enough that I seem reliable to the local businesses for on-the-job injuries.  Workman's comp pays like a trooper, if you keep good documentation.  I am starting to become the one they send these folks to, and I have started to visit the local factories/businesses to offer my services. Businesses tend to have habits of behavior for injuries, and if you are their first choice, you can get some good cases, with great followup coverage.  Here, these businesses are mills and machinist shops, with some logging companies, which have rather specific types of injury.                               JoanneLove cheap thrills? Enjoy PC-to-Phone calls to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

What things do you cover in the two different notes in the

preventative care versus the problem oriented. How do you

separate. It seems like I will deal with complete exam , medication

refills for all problems, get preventative services going like

immunizations ,mammograms, colonoscopy etc. What more are you guys

doing. How easy is it to do this in Alteer.

Brent

>

> > Hi Annie,

> >

> >

> >

> > I've had poor experience with getting the preventative and

chronic

> > dz OV covered, even with 25 modifier. Most insurances in my

area

> > just flat out won't cover them on the same day. I have had

good

> > reimbursement for the prolonged services codes, however.

> >

> >

> >

> > A. Eads, M.D.

> >

> > Pinnacle Family Medicine, PLLC

> >

> > phone fax

> >

> > P.O. Box 7275

> >

> > Woodland Park, CO 80863

> >

> > From:

> > [mailto: ] On Behalf Of

Annie

> > Skaggs

> > Sent: Sunday, April 23, 2006 6:29 AM

> > To:

> > Subject: RE: various issues: learning

> > billing, EOB grooming, and income

> >

> >

> >

> > HI Joanne in Drain,

> >

> >

> >

> > Congrats on your expanding skills. It really is eye-opening to

dig

> > into " working the claims "

> >

> >

> >

> > One thing that stood out to me, however, was your statement that

WC

> > " pays like a trooper " . I hope that continues to be true for

you,

> > but for me, WC is a nightmare. About half the time they never

pay

> > at all, and take a year or more to ever actually deny, so by

then

> > it's too late to try the regular health insurance. When they

do

> > pay, (after 90 days usually), they pay thru subcontracts to

really

> > rotten payers like FirstHealth or BeechStreet, and pay about 60%

of

> > what I would get from most private insurances. Two or three

times

> > over the past 4 years I have gotten 100% of charges, and I

guess

> > that is what has kept me trying, but not anymore. I have just

put

> > in place a policy requiring pay up front from the patients if

they

> > want me to see them for WC or auto insurance related problems.

> > Auto insurance also has occasionally paid 100%, but much more

> > often, by the time they go to the ER, that uses up all the

> > available benefit, so when I see them for the f/u, I get nothing.

> >

> >

> >

> > On a cheerier note, I learned from the practicmgt listserv some

> > tricks like billing preventive plus OV on the same DOS with -25

on

> > the OV for chronic disease mgt, and that has almost doubled my

> > reimbursement for visits where I was giving " one-stop-shopping "

and

> > providing complete preventive service PLUS all their chronic

med

> > refills and disease follow up testing, etc. The only thing I

don't

> > like about it is that I have to write two completely different

> > notes for the one visit, but good thing I do because a couple

times

> > they requested the records before they would pay. I also am

> > getting some payments for 99050, 99058 and now 99051. Next I

am

> > going to try the prolonged service codes.

> >

> >

> >

> > Good luck with your business adventures!

> >

> > Annie

> >

> >

> >

> > Re: various issues: learning

> > billing, EOB grooming, and income

> >

> >

> >

> > From Dr Joanne in Drain, Oregon,

> >

> >

> >

> > The reason you haven't heard much from me recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may be

> > rejected for payment: however; if so, one can rebill straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled to

> > Medicare.

> >

> > No, I didn't fire the part time worker. I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> >

> >

> > Thinking about a second way increase income. I have been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here, these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

> >

> >

> > Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

> >

> >

> >

[Guest guest]

What things do you cover in the two different notes in the

preventative care versus the problem oriented. How do you

separate. It seems like I will deal with complete exam , medication

refills for all problems, get preventative services going like

immunizations ,mammograms, colonoscopy etc. What more are you guys

doing. How easy is it to do this in Alteer.

Brent

>

> > Hi Annie,

> >

> >

> >

> > I've had poor experience with getting the preventative and

chronic

> > dz OV covered, even with 25 modifier. Most insurances in my

area

> > just flat out won't cover them on the same day. I have had

good

> > reimbursement for the prolonged services codes, however.

> >

> >

> >

> > A. Eads, M.D.

> >

> > Pinnacle Family Medicine, PLLC

> >

> > phone fax

> >

> > P.O. Box 7275

> >

> > Woodland Park, CO 80863

> >

> > From:

> > [mailto: ] On Behalf Of

Annie

> > Skaggs

> > Sent: Sunday, April 23, 2006 6:29 AM

> > To:

> > Subject: RE: various issues: learning

> > billing, EOB grooming, and income

> >

> >

> >

> > HI Joanne in Drain,

> >

> >

> >

> > Congrats on your expanding skills. It really is eye-opening to

dig

> > into " working the claims "

> >

> >

> >

> > One thing that stood out to me, however, was your statement that

WC

> > " pays like a trooper " . I hope that continues to be true for

you,

> > but for me, WC is a nightmare. About half the time they never

pay

> > at all, and take a year or more to ever actually deny, so by

then

> > it's too late to try the regular health insurance. When they

do

> > pay, (after 90 days usually), they pay thru subcontracts to

really

> > rotten payers like FirstHealth or BeechStreet, and pay about 60%

of

> > what I would get from most private insurances. Two or three

times

> > over the past 4 years I have gotten 100% of charges, and I

guess

> > that is what has kept me trying, but not anymore. I have just

put

> > in place a policy requiring pay up front from the patients if

they

> > want me to see them for WC or auto insurance related problems.

> > Auto insurance also has occasionally paid 100%, but much more

> > often, by the time they go to the ER, that uses up all the

> > available benefit, so when I see them for the f/u, I get nothing.

> >

> >

> >

> > On a cheerier note, I learned from the practicmgt listserv some

> > tricks like billing preventive plus OV on the same DOS with -25

on

> > the OV for chronic disease mgt, and that has almost doubled my

> > reimbursement for visits where I was giving " one-stop-shopping "

and

> > providing complete preventive service PLUS all their chronic

med

> > refills and disease follow up testing, etc. The only thing I

don't

> > like about it is that I have to write two completely different

> > notes for the one visit, but good thing I do because a couple

times

> > they requested the records before they would pay. I also am

> > getting some payments for 99050, 99058 and now 99051. Next I

am

> > going to try the prolonged service codes.

> >

> >

> >

> > Good luck with your business adventures!

> >

> > Annie

> >

> >

> >

> > Re: various issues: learning

> > billing, EOB grooming, and income

> >

> >

> >

> > From Dr Joanne in Drain, Oregon,

> >

> >

> >

> > The reason you haven't heard much from me recently is that I

am

> > now starting to do my own billing. I had a billing expert who

came

> > in 10 hours a week to bill for me, but I was seeing more

patients,

> > documenting the way she told me to, and not getting more money.

So

> > I decided to bite the bullet and learn Lytec well enough to

bill

> > for myself and find out why.

> >

> > As of two weeks ago, I have been billing the day's

patients

> > the end of every day, and am starting to cream through my old

EOBs

> > and do all the challanges, rebills, charging to secondary

billing,

> > etc,etc that one must do to actually collect what you are

allowed

> > to get from these folks. It is irritating and time consuming,

but

> > it certainly is making me a better coder as well as collecting

a

> > reasonable amount of money.

> >

> > What was happening with my (everyone says including the MD

she

> > is working full time for) skilled billing person, is that she

was

> > skipping the tough ones: For example, Blue Cross Blue Shield

65

> > Plus is supposed to have a primary care provider that they have

to

> > access first. Some of them can come here for very acute

problems

> > if they can't get into their primary provider. They may be

> > rejected for payment: however; if so, one can rebill straight

to

> > Medicare and get them (mostly) covered, except for 15 or 16

> > dollars. I found 25 or 30 of those that never got rebilled to

> > Medicare.

> >

> > No, I didn't fire the part time worker. I have a rule that

> > " you can never hire anyone to do anything you don't all ready

know

> > how to do yourself, better. " I think it was my fault for not

> > learning the system myself first. And the worker is doing a

much

> > better job now, too.

> >

> > I think the business was just getting too busy for one part

> > timer, and I am not willing to hire someone full time for this;

I

> > refuse to become anything but a low overhead practice.

> >

> >

> >

> > Thinking about a second way increase income. I have been here

in

> > Drain long enough that I seem reliable to the local businesses

for

> > on-the-job injuries. Workman's comp pays like a trooper, if

you

> > keep good documentation. I am starting to become the one they

send

> > these folks to, and I have started to visit the local factories/

> > businesses to offer my services. Businesses tend to have habits

of

> > behavior for injuries, and if you are their first choice, you

can

> > get some good cases, with great followup coverage. Here, these

> > businesses are mills and machinist shops, with some logging

> > companies, which have rather specific types of injury.

> >

> >

> >

> > Joanne

> >

> > Love cheap thrills? Enjoy PC-to-Phone calls to 30+ countries

for

> > just 2¢/min with Yahoo! Messenger with Voice.

> >

> >

> >

> >

[Guest guest]

Yes, I agree with you that WC is generally

a nightmare.  No primary care docs in my community accept new WC pt’s. 

The big problem is that you could end up seeing them for multiple visits &

then the claim could still end up getting denied.  You will generally get

nothing for the visits in those cases as those pt’s rarely pay their

bills, even when sent to collections.

Re:

various issues: learning billing, EOB grooming, and

income

From Dr Joanne in Drain, Oregon,

The reason you haven't heard much

from me recently is that I am now starting to do my own billing. I had a

billing expert who came in 10 hours a week to bill for me, but I was seeing

more patients, documenting the way she told me to, and not getting more

money. So I decided to bite the bullet and learn Lytec well enough to

bill for myself and find out why.

As of two weeks ago, I have

been billing the day's patients the end of every day, and am starting to cream

through my old EOBs and do all the challanges, rebills, charging

to secondary billing, etc,etc that one must do to actually collect what

you are allowed to get from these folks. It is irritating and time

consuming, but it certainly is making me a better coder as well as

collecting a reasonable amount of money.

What was happening with my

(everyone says including the MD she is working full time for) skilled billing

person, is that she was skipping the tough ones: For example, Blue Cross

Blue Shield 65 Plus is supposed to have a primary care provider that they have

to access first. Some of them can come here for very acute problems if

they can't get into their primary provider. They may be rejected for

payment: however; if so, one can rebill straight to Medicare

and get them (mostly) covered, except for 15 or 16 dollars. I found 25 or

30 of those that never got rebilled to Medicare.

No, I didn't fire the part time

worker. I have a rule that " you can never hire anyone to do anything

you don't all ready know how to do yourself, better. " I think it was

my fault for not learning the system myself first. And the worker is

doing a much better job now, too.

I think the business was just

getting too busy for one part timer, and I am not willing to hire someone full

time for this; I refuse to become anything but a low overhead practice.

Thinking about a second

way increase income. I have been here in Drain long enough that

I seem reliable to the local businesses for on-the-job injuries.

Workman's comp pays like a trooper, if you keep good documentation. I am

starting to become the one they send these folks to, and I have started to

visit the local factories/businesses to offer my services. Businesses tend

to have habits of behavior for injuries, and if you are their first choice, you

can get some good cases, with great followup coverage. Here, these

businesses are mills and machinist shops, with some logging companies,

which have rather specific types of injury.

Joanne

Love

cheap thrills? Enjoy PC-to-Phone calls

to 30+ countries for just 2¢/min with Yahoo! Messenger with Voice.

[Guest guest]

When you bill for a preventive physical, plus bill a problem f/u

separately on the same day, do you charge a co-pay for the problem

f/u part of the visit? For a preventive visit alone, the patient

doesn't have to pay a co-pay.

--Padma

>

> CPT guidelines for use of preventive codes requires

a " comprehensive

> history (past medical/social) and ROS " , but does not require a CC

or

> HPI at all. Typically for a physical, my HPI includes the " here

for

> screening " statement, plus whatever the patient says to me that

seems

> pertinent, eg " I have had a really good year. I haven't been sick

once,

> and I joined a gym in January and lost 7 lbs already "

>

> For the multi problem f/u I " point and drag " the pertinent

diagnoses

> from the problem list and if there are 3 or more, that by itself

gets me

> all the " bullets " I need for a -14, but usually I add some free

text

> descriptions anyway: under Hypertension, I might say, " Brings her

> records of readings at home, showing SBP ranging from 114-148, most

> readings in the 120s. " Stuff like that. I try to freetext what I

> really need, and not much more. If they have a complaint (symptom)

> related (or not) to the diagnoses, I will pull that in and use the

point

> and click system in A4 to describe that because it is faster than

> freetext.

> Hope that helps,

> Annie

>

>

[Guest guest]

Some do not require a co-pay for preventive care in our area, others

do.

I'm going to try billing for problem f/u separately from the physical--

so far none of my collegues know to do so, so will try and see.

Thanks,

Padma

[Guest guest]

Let us know how it works.

Brent

>

> Some do not require a co-pay for preventive care in our area, others

> do.

>

> I'm going to try billing for problem f/u separately from the physical-

-

> so far none of my collegues know to do so, so will try and see.

>

> Thanks,

> Padma

>

[Guest guest]

Thanks for all the useful information from this list serve. Invaluable.I have a billing question along these lines. Doing my own billing, using Alteer version 5.1. Up and going SLOWLY for 4 months. I did a home visit at 10pm for 2 pediatric patients in the same household. Other than the ICD-9 and cpt codes, what other codes can I use? n Bobb-McKoy Annie Skaggs wrote: 99050 is for urgent service outside posted hours. I use it if I have to open the office back up to see someone after closing or if I come in on the weekend or a holiday. 99058 is for emergency services in the office. The guidelines say for service requiring the physician to disrupt the schedule. I define that as anything that pulls me away from another patient or causes me not to be available for a scheduled appointment. The walk in Chest Pain is the classic example. I

DON’T use it if I happen to not have a scheduled appointment at the time of the walk in, but if I have a 2:00 scheduled and CP walks in at 1:55 and causes me to make the 2:00 wait til after EMS comes then I DO charge it. 99051 is a new code this year. It is for “regularly scheduled (not urgent) appointments on holidays or

Sundays” I didn’t know about it until March, when some folks on Practicemgt said they went back and billed it for patients seen on Jan 2nd and MLK day and had been paid by at least some insurers. I then rebilled too, but haven’t got any responses yet. I will have to look back to see if this code can also be used for evening appointments. I sort of think I recall reading that it can be. For example, my posted hours are ‘til

4:30, but usually once or twice a month I end up running an evening clinic for people who can’t get off work for their physical during the day. Seems to me that an additional charge is appropriate for giving up dinner with my family to do pap smears until 9pm, even though it isn’t “urgent” Medicare doesn’t pay any of these, and some insurances consider them noncovered. I have posted my regular office hours are and included notice that appointments at other times are subject to “an administrative fee that may not be covered by your insurance”. At first I posted an amount of $25, but now I leave that off because I bill $55 to insurance, but if the patient has to pay it I will take it down to $25. My vet charges $75 for the same service, so I don’t think $25 is unreasonable. Annie Re: various issues: learning billing,> EOB grooming, and income>> From Dr Joanne in Drain, Oregon,>> The reason you haven't heard much from me recently is that I am now> starting to do my own billing. I had a billing expert who came in 10> hours a week to bill for me, but I was seeing more patients, documenting> the way she told me to, and not getting more money. So I decided to> bite the bullet and learn Lytec well enough to bill for myself and find> out why.> As of two weeks ago, I have been billing the day's patients the end> of every day, and am starting to cream through my old EOBs and do all> the challanges, rebills, charging to secondary billing, etc,etc that one> must do to actually collect what you are allowed to get from

these> folks. It is irritating and time consuming, but it certainly is making> me a better coder as well as collecting a reasonable amount of money.> What was happening with my (everyone says including the MD she is> working full time for) skilled billing person, is that she was skipping> the tough ones: For example, Blue Cross Blue Shield 65 Plus is supposed> to have a primary care provider that they have to access first. Some of> them can come here for very acute problems if they can't get into their> primary provider. They may be rejected for payment: however; if so,> one can rebill straight to Medicare and get them (mostly) covered,> except for 15 or 16 dollars. I found 25 or 30 of those that never got> rebilled to Medicare.> No, I didn't fire the part time worker. I have a rule that "you

can> never hire anyone to do anything you don't all ready know how to do> yourself, better." I think it was my fault for not learning the system> myself first. And the worker is doing a much better job now, too.> I think the business was just getting too busy for one part timer,> and I am not willing to hire someone full time for this; I refuse to> become anything but a low overhead practice.>> Thinking about a second way increase income. I have been here in> Drain long enough that I seem reliable to the local businesses for> on-the-job injuries. Workman's comp pays like a trooper, if you keep> good documentation. I am starting to become the one they send these> folks to, and I have started to visit the local factories/businesses to> offer my services. Businesses tend to have habits of behavior for> injuries,

and if you are their first choice, you can get some good> cases, with great followup coverage. Here, these businesses are mills> and machinist shops, with some logging companies, which have rather> specific types of injury.>> Joanne> _____>> Love cheap thrills? Enjoy PC-to-Phone calls> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for just> 2¢/min with Yahoo! Messenger with Voice.>

[Guest guest]

Thanks for all the useful information from this list serve. Invaluable.I have a billing question along these lines. Doing my own billing, using Alteer version 5.1. Up and going SLOWLY for 4 months. I did a home visit at 10pm for 2 pediatric patients in the same household. Other than the ICD-9 and cpt codes, what other codes can I use? n Bobb-McKoy Annie Skaggs wrote: 99050 is for urgent service outside posted hours. I use it if I have to open the office back up to see someone after closing or if I come in on the weekend or a holiday. 99058 is for emergency services in the office. The guidelines say for service requiring the physician to disrupt the schedule. I define that as anything that pulls me away from another patient or causes me not to be available for a scheduled appointment. The walk in Chest Pain is the classic example. I

DON’T use it if I happen to not have a scheduled appointment at the time of the walk in, but if I have a 2:00 scheduled and CP walks in at 1:55 and causes me to make the 2:00 wait til after EMS comes then I DO charge it. 99051 is a new code this year. It is for “regularly scheduled (not urgent) appointments on holidays or

Sundays” I didn’t know about it until March, when some folks on Practicemgt said they went back and billed it for patients seen on Jan 2nd and MLK day and had been paid by at least some insurers. I then rebilled too, but haven’t got any responses yet. I will have to look back to see if this code can also be used for evening appointments. I sort of think I recall reading that it can be. For example, my posted hours are ‘til

4:30, but usually once or twice a month I end up running an evening clinic for people who can’t get off work for their physical during the day. Seems to me that an additional charge is appropriate for giving up dinner with my family to do pap smears until 9pm, even though it isn’t “urgent” Medicare doesn’t pay any of these, and some insurances consider them noncovered. I have posted my regular office hours are and included notice that appointments at other times are subject to “an administrative fee that may not be covered by your insurance”. At first I posted an amount of $25, but now I leave that off because I bill $55 to insurance, but if the patient has to pay it I will take it down to $25. My vet charges $75 for the same service, so I don’t think $25 is unreasonable. Annie Re: various issues: learning billing,> EOB grooming, and income>> From Dr Joanne in Drain, Oregon,>> The reason you haven't heard much from me recently is that I am now> starting to do my own billing. I had a billing expert who came in 10> hours a week to bill for me, but I was seeing more patients, documenting> the way she told me to, and not getting more money. So I decided to> bite the bullet and learn Lytec well enough to bill for myself and find> out why.> As of two weeks ago, I have been billing the day's patients the end> of every day, and am starting to cream through my old EOBs and do all> the challanges, rebills, charging to secondary billing, etc,etc that one> must do to actually collect what you are allowed to get from

these> folks. It is irritating and time consuming, but it certainly is making> me a better coder as well as collecting a reasonable amount of money.> What was happening with my (everyone says including the MD she is> working full time for) skilled billing person, is that she was skipping> the tough ones: For example, Blue Cross Blue Shield 65 Plus is supposed> to have a primary care provider that they have to access first. Some of> them can come here for very acute problems if they can't get into their> primary provider. They may be rejected for payment: however; if so,> one can rebill straight to Medicare and get them (mostly) covered,> except for 15 or 16 dollars. I found 25 or 30 of those that never got> rebilled to Medicare.> No, I didn't fire the part time worker. I have a rule that "you

can> never hire anyone to do anything you don't all ready know how to do> yourself, better." I think it was my fault for not learning the system> myself first. And the worker is doing a much better job now, too.> I think the business was just getting too busy for one part timer,> and I am not willing to hire someone full time for this; I refuse to> become anything but a low overhead practice.>> Thinking about a second way increase income. I have been here in> Drain long enough that I seem reliable to the local businesses for> on-the-job injuries. Workman's comp pays like a trooper, if you keep> good documentation. I am starting to become the one they send these> folks to, and I have started to visit the local factories/businesses to> offer my services. Businesses tend to have habits of behavior for> injuries,

and if you are their first choice, you can get some good> cases, with great followup coverage. Here, these businesses are mills> and machinist shops, with some logging companies, which have rather> specific types of injury.>> Joanne> _____>> Love cheap thrills? Enjoy PC-to-Phone calls> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for just> 2¢/min with Yahoo! Messenger with Voice.>

[Guest guest]

I would be shocked if any of the big

insurers around here (UHC, Aetna, Anthem, Med Mutual) pay any of those after hours/emergency

codes.  I tried the weekend code once or twice & they were not paid.  As

always, that is all just “bundled into the regular payment”.

Re: various issues: learning billing,

> EOB grooming, and income

>

> From Dr Joanne in Drain, Oregon,

>

> The reason you haven't heard much from me recently

is that I am now

> starting to do my own billing. I had a billing expert who came in 10

> hours a week to bill for me, but I was seeing more patients, documenting

> the way she told me to, and not getting more money. So I decided to

> bite the bullet and learn Lytec well enough to bill for myself and find

> out why.

> As of two weeks ago, I have been billing the

day's patients the end

> of every day, and am starting to cream through my old EOBs and do all

> the challanges, rebills, charging to secondary billing, etc,etc that one

> must do to actually collect what you are allowed to get from these

> folks. It is irritating and time consuming, but it certainly is

making

> me a better coder as well as collecting a reasonable amount of money.

> What was happening with my (everyone says

including the MD she is

> working full time for) skilled billing person, is that she was skipping

> the tough ones: For example, Blue Cross Blue Shield 65 Plus is

supposed

> to have a primary care provider that they have to access first. Some

of

> them can come here for very acute problems if they can't get into their

> primary provider. They may be rejected for payment:

however; if so,

> one can rebill straight to Medicare and get them (mostly) covered,

> except for 15 or 16 dollars. I found 25 or 30 of those that never

got

> rebilled to Medicare.

> No, I didn't fire the part time worker. I

have a rule that " you can

> never hire anyone to do anything you don't all ready know how to do

> yourself, better. " I think it was my fault for not learning the

system

> myself first. And the worker is doing a much better job now, too.

> I think the business was just getting too busy for

one part timer,

> and I am not willing to hire someone full time for this; I refuse to

> become anything but a low overhead practice.

>

> Thinking about a second way increase income. I have been

here in

> Drain long enough that I seem reliable to the local businesses for

> on-the-job injuries. Workman's comp pays like a trooper, if you keep

> good documentation. I am starting to become the one they send these

> folks to, and I have started to visit the local factories/businesses to

> offer my services. Businesses tend to have habits of behavior for

> injuries, and if you are their first choice, you can get some good

> cases, with great followup coverage. Here, these businesses are

mills

> and machinist shops, with some logging companies, which have rather

> specific types of injury.

>

>

Joanne

> _____

>

> Love cheap thrills? Enjoy PC-to-Phone calls

> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com

> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for

just

> 2¢/min with Yahoo! Messenger with Voice.

>

[Guest guest]

I would be shocked if any of the big

insurers around here (UHC, Aetna, Anthem, Med Mutual) pay any of those after hours/emergency

codes.  I tried the weekend code once or twice & they were not paid.  As

always, that is all just “bundled into the regular payment”.

Re: various issues: learning billing,

> EOB grooming, and income

>

> From Dr Joanne in Drain, Oregon,

>

> The reason you haven't heard much from me recently

is that I am now

> starting to do my own billing. I had a billing expert who came in 10

> hours a week to bill for me, but I was seeing more patients, documenting

> the way she told me to, and not getting more money. So I decided to

> bite the bullet and learn Lytec well enough to bill for myself and find

> out why.

> As of two weeks ago, I have been billing the

day's patients the end

> of every day, and am starting to cream through my old EOBs and do all

> the challanges, rebills, charging to secondary billing, etc,etc that one

> must do to actually collect what you are allowed to get from these

> folks. It is irritating and time consuming, but it certainly is

making

> me a better coder as well as collecting a reasonable amount of money.

> What was happening with my (everyone says

including the MD she is

> working full time for) skilled billing person, is that she was skipping

> the tough ones: For example, Blue Cross Blue Shield 65 Plus is

supposed

> to have a primary care provider that they have to access first. Some

of

> them can come here for very acute problems if they can't get into their

> primary provider. They may be rejected for payment:

however; if so,

> one can rebill straight to Medicare and get them (mostly) covered,

> except for 15 or 16 dollars. I found 25 or 30 of those that never

got

> rebilled to Medicare.

> No, I didn't fire the part time worker. I

have a rule that " you can

> never hire anyone to do anything you don't all ready know how to do

> yourself, better. " I think it was my fault for not learning the

system

> myself first. And the worker is doing a much better job now, too.

> I think the business was just getting too busy for

one part timer,

> and I am not willing to hire someone full time for this; I refuse to

> become anything but a low overhead practice.

>

> Thinking about a second way increase income. I have been

here in

> Drain long enough that I seem reliable to the local businesses for

> on-the-job injuries. Workman's comp pays like a trooper, if you keep

> good documentation. I am starting to become the one they send these

> folks to, and I have started to visit the local factories/businesses to

> offer my services. Businesses tend to have habits of behavior for

> injuries, and if you are their first choice, you can get some good

> cases, with great followup coverage. Here, these businesses are

mills

> and machinist shops, with some logging companies, which have rather

> specific types of injury.

>

>

Joanne

> _____

>

> Love cheap thrills? Enjoy PC-to-Phone calls

> <http://us.rd.yahoo.com/mail_us/taglines/postman9/*http:/us.rd.yahoo.com

> /evt=39666/*http:/beta.messenger.yahoo.com/> to 30+ countries for

just

> 2¢/min with Yahoo! Messenger with Voice.

>