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Insurance Billing manual updates:
There will be a new billing form in April 2007- The CMS 1500 form that is
quite similar to the HCFA 1500 but with a few small changes one being a box for
your National Provider Number.
Starting May 2007 if you are billing insurance companies you will need a
National Provider number.
I have also added quite a lot of information on the legalities of doing
business with third party payers on the blog after taking a seminar from two
attorneys that were hired by AMTA-WA to help us here in WA State with our
provider contracts.
The main points were:
- If you are billing a higher rate to the insurance companies than you are
your cash clients you are committing insurance fraud. You can try to
explain it any way you want - you are doing medical massage, it requires
more paperwork and time, it takes longer to pay, everyone else is doing it,
I have a cash discount -whatever it is- you STILL have to PROVE IT in a
court of law if ever questioned. Do you feel comfortable knowing that
and knowing what your reason is? Insurance Fraud is punishable by 5 years in
prison and $5000 per occurrence. Is it worth that risk?
- You can charge an extra fee in the amount that you would or do pay a
billing service to do the billing which is usually 10-15% of your bill.
- If you are working for a chiropractors office or other health care
provider and are hired as a subcontractor it is illegal for the chiropractor
to pay you a percentage of the amount charged as it is considered a
kickback. The best way is to pay a flat rate as rent. If you are
paid as an employee, it is ok to be paid a percentage.
- Be sure to read any contract that you sign very carefully and understand
all of the terms because you are required to comply with them.
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