NEW Online Medical Billing Course

New Comprehensive Medical Billing Study Course offered by medical billing experts Alice Scott, Michele Redmond and Merry Schiff designed specifically for the medical biller to understand complete practice management.  Because it is designed by experts currently operating a billing service today the courses include important information often omitted from other courses.

In hiring employees who have graduated from medical billing courses for their medical billing business Alice and Michele found a disconnect between the classroom and workplace in the knowledge required for the actual work in the field of medical insurance billing.  In many courses much time is spent on subjects not really relevant to billing insurance claims with information not required for the job of billing.  Many courses lack or don’t go into enough depth on topics that are crucial to billing.

Partnering with teacher/author Merry Schiff and Linda Walker, Alice and Michele are bridging this gap with their new course designed to teach a student exactly what they need to move into the field of medical billing with the tools they need to succeed along with free support as they learn.

Merry found that in developing a course for a university she was limited in what she could offer and was directed as to what should be included in the course.  She was unable to include topics she felt important to include.   Merry is very passionate about this industry and wanted to create a course that included all aspects that a biller would need to succeed in this field.  When Alice and Michele started their billing service back in the early 1990s Merry was one of their first mentors.   Merry was interested in teaming up with Alice and Michele as she liked their writing style and ability to communicate with the reader in easy to understand language.

Linda Walker founded a medical billing business in 1997 after over 10 years experience as a claims examiner with major health insurance company.  She is the founder of Practice Managers Resource & Networking Community with over 7000 subscribers.  Linda also holds an Associate’s Degree in Business Administration, a paralegal certification along with various other designations in the health insurance industry.  She is passionate about legal issues that affect healthcare and her primary focus is on consulting.

Alice and Michele used their experience with training employees combined with Merry’s experience in writing and teaching and Linda’s knowledge and background to develop a comprehensive course designed to cover exactly the knowledge required to start working in the medical billing field.  They have the perfect combination of working knowledge and experience to develop a well rounded course designed to bring the student up to speed much quicker than other courses.

The first three courses will be released October 15, 2013

Online at

Courses offered are:

Medical Billing Study Course containing 10 separate courses which can be purchased individually or as a package including

1                     Introduction to Medical Billing

2                     Understanding Coding and Modifiers

3                     Life Cycle of an Insurance Claim

4                     Billing Medicare, TRICARE and Medicaid

5                     Billing the Blues, Commercial, Disability and Workers Comp Claims

6                     Working with the Practice Management System

7                     Reading EOBs, Handling Denials and Filing Appeals

8                     HIPAA and Legal Issues

9                     Operating a Medical Billing Business

10     Marketing a Medical Billing Business

Alice Scott & Michele Redmond are mother/daughter owners of a medical billing service for the past 19 years and bill for providers all over the United States.  They are authors of 15 books on the subject of medical billing that are available both online and through Amazon.  They have trained other billers from all over the United States both in billing and running a medical billing business.   Alice & Michele have consulted with many medical offices across the US on topics ranging from HIPAA compliance to analysis of billing practices.

Merry Schiff has 54 years of experience consulting and training medical billers.  She contracted with a major online university to create and teach a medical billing course with more than 1500 students.  Merry founded and is the Executive Director of the first professional medical billing association, NEBA, with over 1000 members.  Her experience ranges from owning and operating a medical billing business to writing an 800 page medical billing textbook to developing the first home study medical billing course.

10 Essential Health Benefits Under Obamacare

While it is difficult to tell what will happen with the Affordable Care Act there are 10 essential health benefits that this law says must be met on all health plans offered to those who buy health insurance on their own or in small groups .  Large employers are not required to offer these benefits but it is expected that most already do or will.    The bill would like to establish these 10 benefits as a standard for health insurance coverage.  A study by an independent research firm shows that on average 76% of these benefits are offered by insurance plans today.   These 10 benefits are:

  1. Emergency care –  Under the Affordable Care Act visits to the emergency room do not require preauthorization and the patient cannot be charged out of network
  2. Prescription drugs – The biggest part of this part of the bill is that it narrows and eventually closes the Medicare Part D doughnut hole which is a gap in drug coverage when over $2970 per year is spent on medications.
  3. Outpatient care –  This is offered by most insurance plans now as it is the most common form of healthcare.
  4. Mental health services – Some states already have legislation in place regarding mental health coverage. The Affordable Care Act will require mental health be covered but copays may be as much as $40 and may be limited to a certain number of annual visits
  5. Hospitalization – Coverage for hospital visits will be required but patient costs may still be fairly high.
  6. Rehabilitation and Habilitation services – While most insurance plans cover rehab services the new law will also cover habilitative services which are therapies for long-term disabilities.
  7. Preventative wellness – The US Preventive Services Task Force lists 50 preventive services which the new law will cover at no extra cost to the insured.  Medicare beneficiaries may be able to receive additional screenings copay and deductible free.
  8. Laboratory services – Lab services will include preventative screening tests.
  9. Pediatric care – Some dental and vision coverage will be covered for children under the age of 19 including 2 teeth cleanings per year, X-rays, fillings and medically necessary orthodontics.  Also covered are one eye exam and pair of glasses or contacts for anyone under the age of 19.
  10. Maternity and newborn care – Prenatal care is classified as preventive under the new law and must be covered at no extra cost.  Also covered are childbirth and newborn care.

Remember that not all insurance plans are required to conform to these rules .  These laws are for insurance plans that are offered to those who buy health insurance on their own or in small groups.  Many insurance plans already include many of these.

Medicare Revalidation

What Does it Mean When Medicare Sends a Letter to Revalidate?

Once again, Medicare is asking providers to revalidate already existing information for their PTAN to remain in effect. So what now… Do you have to just send in your license or do you have to resend everything again like you did when you first applied?

Unfortunately, you have to do the latter, which is to resend all the applications again as if you were a new provider in order revalidate your PTAN. The only difference is on the CMS-855I Medicare application and the CMS-855B Medicare application should check Revalidation in section 1A instead of New Enrollment to indicate the application is being submitted to revalidate the group or individual provider. Providers that reassign their benefits to the group should submit the 855I and 855R as part of the revalidation process for the group.

The CMS-588 Electronic Funds Medicare application only has to be submitted if the group is not receiving payments electronically.

The CMS-460 Medicare Participating Physician or Supplier Agreement application does not need to be submitted because revalidation does not  affect the current participation status of providers.
After you have had all parties sign and date the applications make a copy in case you are asked to change or resubmit any information regarding the application. It’s easier to work from an existing application than to try and remember what you sent in on the first application.

Pecos is also another option but one I don’t use because I’ve encountered a lot of problems when I did try to use it. I also find it to be a very difficult system to navigate; the customer service on how to navigate the system is nonexistent. But that is for another blog….

Lastly, do not forget to send in a copy of the Medicare Revalidation letter you received with the application. The letter is the only way Medicare has of tracking the group application and applying the information to the correct request for revalidation.

For more information on how to do this and other forms of credentialing please visit my website at for a full price list and detailed outline of different costs for the best way to credential, which is to have a specialist do it right the first time. You can also call me at (314) 440-1244.

Best regards,
Carolyn Wilkinson