Are You Ready for 2010

The end of the year is approaching fast. There are many things that need to be done as the new year is welcomed in to prevent your office from losing money. It is best to be ahead of the game to prevent revenue loss. If you plan ahead and organize, you can breeze into the new year with smooth sailing.

One thing that needs to be done before the first of the year is authorization switches. If you are in an office that requires authorization for your services you may have to have the authorizations moved over to the new year. Many carriers have the authorizations end on December 31st of the current year. There may still be unused visits, but the authorization must be moved into the new year. If you are an office that deals with authorizations, make sure your auths are in order for the new year. If you bill for providers who deal with authorizations you may want to remind them to make sure their auths are in order.

There are also many insurance carriers who base their timely filing on the end of the year. For example, one of the larger carriers in our area has a timely filing limit of March 31st for all claims for services in the previous year. If you have carriers with this type of timely filing rule then it is important to do the followup on any outstanding claims. Don’t wait until March 29th. That is too late. It seems like a no brainer, but you wouldn’t believe how many offices lose money to timely filing. Followup should be done regularly all year long, but if you have a carrier that you know has a timely filing limit based on the end of the year you should plan for it. If you do the followup in early January you will leave yourself plenty of time to check them again and resubmit if necessary before the limit.

Whether timely filing is an issue or not, it is good practice to clean up any outstanding claims from the previous year as quickly as possible. There is a better chance of having the most favorable outcome on a claim, which for most of us is payment, when the claim is processed as soon as possible after the services were provided. Claims left to drag on and on into the next year are not as likely to be paid.

We like to go through the office in December and see if we need to make any changes. We review our filing needs to reorganize our files. As we grow, so does our need to file information received from our providers. December is the month we like to clean out our file cabinets and move information no longer needed into storage. We like to step back and look around and see if in our haste to get our work completed we have overlooked things that could simplify our work.

Many of us set New Year resolutions with grand plans of all the things we would like to accomplish in the next 12 months. It’s a good idea to review last year’s resolutions to see if you have been realistic in your planning. Don’t just make these resolutions, but make a plan to implement them.

Of course, we must consider that tax time is quickly approaching and it’s a good idea to organize your records to prepare for income tax filing. It is good to have systems in place for dealing with end of the year issues. It will make the process of transitioning into the new year much easier.

Medical Billing

Expand Your Medical Billing Business

Later this month we will be releasing our newest book. The reason we are so excited about this book is that it will offer the new medical billing service a way to increase their income while expanding their marketing by providing an added service. We discovered this effective marketing technique quite accidentally. Actually it arose as the result of a challenge/problem.

A few years ago we were billing for an eye doctor who worked at Wal-Mart eye centers. He kept moving around to different Wal-Mart locations. Each time he took on a new location it required a new Medicare application and notification to all the insurance carriers he participated with. At that time we took care of any credentialing needs of our providers free of charge. After the fourth or fifth Medicare application, we decided we couldn’t do this any more. (Sometimes we are slow learners.)

We started charging for our credentialing services and found that our doctors referred us to other doctors for their credentialing too. We started getting calls for credentialing that also lead to leads for billing. The beauty of the credentialing was that we got paid up front for the service. We got paid by credit card for an application when we finished the application. We didn’t have to wait until the money came in from the insurance carrier and then for the provider to get billed and pay us. This can be a great advantage to a new biller in so many ways.

First of all, it brings in cash much sooner than billing will to a struggling new business. Cash flow was definitely a problem when we started our business and credentialing income back then would have greatly helped our success.

Secondly, much of our credentialing business is from beginning providers who may be looking for a billing service or at least open to hearing about your billing service after you have done a great job handling their credentialing needs. These new providers aren’t that much different than you are. They too need help in getting their medical business started. The most difficult part of marketing a medical billing business is getting to talk to the provider to tell them about your service. When you offer credentialing services, you find doctors calling you.

So how do you get started with your credentialing services? That’s what we are so excited about. We spent the last six months writing our first credentialing book “Medicare Enrollment – Completing the 855I Correctly”. This is the first of a series of credentialing books we are writing and will explain everything you need to know about successfully completing a Medicare application. We explain how to determine which forms you need to complete for each situation, where to find and exactly how to complete the application, what pitfalls to avoid for quicker processing, and we provide you with a list of the required information a provider needs to send to you. Basically we provide everything you need to start completing Medicare applications for providers.

We will be releasing our new book “Medicare Enrollment – Completing the 855I Correctly” in mid December. Watch for the announcement in an email. If you are interested in pre-ordering this ebook, you can send me an email at

Medical Billing


Facilities Billing on UB04 Forms

It used to be that only hospitals and ambulatory surgery centers were considered facilities and needed to file their claims on UB04 forms. But there are many other providers that are also classified as facilities that are now being required to file their claims on UB04 forms as well.

Many out patient drug and alcohol rehabilitation providers are classified as facilities. In the past they were allowed to file claims on CMS 1500 forms. Recently we are seeing a trend where more and more insurance carriers are requiring these providers to now bill on facility claim forms, or UB04’s.

This presents a problem for these smaller ‘facility’ providers. They do not usually have a professional biller or coder on staff. The person, or people who have been doing their billing have no experience with UB04 forms and don’t know what a rev code is. Some start out thinking it can’t be that much different, but in reality UB04’s and CMS 1500’s are very different.

The UB04 form requires rev codes and a type of bill along with the CPT codes that are used on the CMS form. The format of the UB04 is totally different as well. It is important that you know exactly which fields need to be completed and what information goes in them. We most commonly see denials for incorrect type of bill.

Another problem is that most practice management systems do not come with the capability to print UB04’s. So how do you get the computer to print them out? If you are lucky, your practice management system will allow you to print a UB04, but unfortunately that is not the norm. So you have to find another way. There are some inexpensive UB04 fill and print softwares out there, but that means double entry. You have to put the data in the UB04 software to print the form, and you have to enter it into your practice management system to track the claim. Still this is a reasonable option for some.

Many others fill the forms out by hand, or by typewriter. Personally, not an option for me. However, some carriers will not take handwritten forms anymore, so this may not work. Another way around this is to outsource the claims to someone with the capability of filing on UB04’s.

If you find yourself in a position where you need to switch over from CMS 1500 forms to UB04 forms the best thing to do is evaluate your situation and decide what will work best. If you are capable of filing the forms yourself, then become familiar with the UB04 form and how it needs to be completed. There are resources out there to help.

The PMBA (Professional Medical Billers Association) offers a course called Facility Billing 101 which covers all aspects of billing on the UB04 forms. The cost is only $99 for PMBA members and $129 for non-members. You can get more information here.

UB04 Forms