Billing qualifier ID and its meaning

0B – ANSI – State License#

1A – ANSI – Blue Cross Provider ID#

1B – ANSI – Blue Shield Provider#

1C – ANSI – Medicare Provider#

ID – ANSI – Medicaid Provider#

IG – ANSI – Provider UPIN#

1H – ANSI - CHAMPUS ID#

1J – ANSI - Facility ID#

B3 – ANSI - Preferred Provider Org

BQ – ANSI - Health Maintenance Org Code#

EI – ANSI - Employers ID#

FH – ANSI - Clinic#

G2 – ANSI - Provider Commercial#

G5 – ANSI - Provider Site#

LU – ANSI - Location#

SY – ANSI - Social Security#

U3 – ANSI - The Social Security# may not be used for

X5 – ANSI – Medicare. Unique Supplier ID# (USIN)

N4 – ANSI – Provider plan Network ID#

ZZ – ANSI – Taxonomy code

Selecting the Right Medical Billing Service - 5 Things to Consider

Medical billing is crucial part of any health care facility even though it is not the main line of activity in such workplaces. There are many time consuming issues related to medical billing. Medical professionals are often overworked, and may not have time to attend to such issues. But ignoring this function may lead to severe repercussions such as drying up of funds, or even legal complications related to Medicare frauds. Therefore, this function deserves due respect.

One way to reduce medical billing procedures encroaching upon the health care functions is to off load the function to specialized medical billing services. Such offloading is advantageous even for smaller medical practices, as it leaves more time on hand for the professional work. There are many medical billing service providers. It becomes difficult to select the right one from these. In order to get the right medical billing company, following five points need to be considered. 

1.    Where is the medical billing service located?

Location of such services is crucial because patients often have queries regarding their medical bills. Services of overseas medical billing companies are cheaper, but they may prove to be expensive for patients. In addition, there can be other issues such as accent or lack of familiarity with procedures in the country where health care facility is located.

2.    Is the medical billing company adequately experienced?

Experience is very important in this field. This is because terminology related to medical billing is quite different from other types of billing. In addition, billing is linked to medical reimbursements. Therefore, any such billing information should be accurate. It should also comply with all relevant legal stipulations. 

3.    How efficient is the medical billing service in getting reimbursement?

Medical billing is a set of smaller functions like entering data, submitting claims for getting reimbursement, patient billing, payment posting, and follow up for reimbursement, and handling denial issues. The company that offers comprehensive service should be preferred over others. In addition, the company that systematically and regularly obtains the reimbursements in shorter time should be preferred. 

4.    What sort of reports can the company generate, and how frequently?

Medical billing is not exclusively about generating bills, and obtaining reimbursements. It is also about generating different reports from the available data. Such reports should give the medical professional an idea about the financial health of the practice or health care facility as the case may be.

5.    Does the company guarantee data security?

There are legal stipulations relating to patient’s rights to privacy. Security of medical billing data is therefore important because information on it can lead to Medicare and other frauds, which could implicate the health care facility and lead to protracted legal battles. 

Medical billing contract - things to consider - reponsiblity and duty

Medical Billing Contracts

If you are going to try and create your own medical billing company, you should have a medical billing contract.  You can either have a basic contract, or have an attorney draft up a contract.  

In the contract there are some things to consider

Name of the billing company and the name of client.

Effective date of contract and expiration date if any.

Where will the insurance payments go to?  I recommend having the payments go to the physician's office to avoid any legal matters. There should be a contract stating the provider will send copies of EOB's of all payments.

Providing monthly reports or meeting once a month or quarterly.

How will payments be made?  You can either charge by percentage. Some of the average ranges are 8 to 15% or an average of $4 to $10 per claim.  Things to consider are the patient volume, average income and if the client is established or not.

Who will do the coding?  You will want to interview the company that you will be outsourcing with to make sure they are not doing anything illegal first.  You do not want to do billing for a company that is in violation.

Once you have interviewed with them, you can either agree to have coding stay with them or choose to outsource coding as well for an additional fee.

Things that the client is responsible for: 

provide true and accurate data(the client will be responsible for any submission of false date that can be prosecuted by law)

verify insurance

client will be responsible for his/her own credentialing

client will not offer kickbacks or professional courtesy to client(this means the client can not wave copay or give free services to preferred patients, THIS IS AGAINST THE LAW)

      

Note that claims and patient information belongs to the property of the client and the billing company is only using it while contracted with the client.

Billing company is responsible for 

following up on unpaid claims

patient billing

paper and electronic submission of claims

If you are going to try and create your own medical billing company, you should have a medical billing contract. You can either have a basic contract, or have an attorney draft up a contract.

In the contract there are some things to consider

Name of the billing company and the name of client.

Effective date of contract and expiration date if any.

Where will the insurance payments go to? I recommend having the payments go to the physician's office to avoid any legal matters. There should be a contract stating the provider will send copies of EOB's of all payments.

Providing monthly reports or meeting once a month or quarterly.

How will payments be made? You can either charge by percentage. Some of the average ranges are 8 to 15% or an average of $4 to $10 per claim. Things to consider are the patient volume, average income and if the client is established or not.

Who will do the coding? You will want to interview the company that you will be outsourcing with to make sure they are not doing anything illegal first. You do not want to do billing for a company that is in violation.

Once you have interviewed with them, you can either agree to have coding stay with them or choose to outsource coding as well for an additional fee.

Things that the client is responsible for: provide true and accurate data(the client will be responsible 

for any submission of false date that can be prosecuted by law)

verify insurance

client will be responsible for his/her own credentialing

client will not offer kickbacks or professional courtesy to client(this means the client can not wave 

copay or give free services to preferred patients, THIS IS AGAINST THE LAW)

Note that claims and patient information belongs to the property of the client and the billing company is only using it while contracted with the client.

Billing company is responsible for following up on unpaid claims

patient billing

paper and electronic submission of claims