the responsibility of the legality of that billing is 100% still yours, the Provider

Below are a few audio webinars on Out of Network Billing, Patient Collections, Billed Charges, Telemedicine and some recently shared pointers. Audio credit to Audio Educator shared pointers credit to Larsen Billing Company

  1. The Balance Billing Requirement – Why Out-of-Network Providers Must Balance Bill Their Patients

https://audioeducator-mp3.s3.amazonaws.com/2015/May/05-05-2015-Force-TLCTCI515B.zip

  1. Telemedicine 2017: Coding, Billing and Compliance Update

https://audioeducator-mp3.s3.amazonaws.com/2017/March/3zotSC2wb967662d81cGiA0zYWQ2ubf6e0f3fd4.zip

  1. Reconciling Cigna v. Humble with Aetna v. Humble and Their Impact on the Out-of-Network Provider

https://audioeducator-mp3.s3.amazonaws.com/2017/March/M6Nwt2EHQNf9ad70233eYE06AwhPIm92895d8521.zip

4. Larsen Billing – You, the provider, are responsible for coding. Billing services give advice and make suggestions on coding all the time, but if you cannot find evidence in the code books for the advice as it pertains to your services, you should not allow them to bill on your behalf. So even if your billing service picks your codes, you have ultimate responsibility for all of them.

  • States vary, but there is no overall statute of limitations on take backs, audits, or insurance fraud. That means that even if a code pays for ten years, it could be audited or investigated by the insurance company or local authorities, and you will be held liable to pay back, usually with interest, all funds that were improperly coded. A good billing service stands by their billing and coding and will help you gather the needed information in the case of an audit.

United Health Care insufficient record bogus Denial

United Health Care has started a recent trend… just wait, it is not a good trend. UHC has denied claims stating insufficient medical records even though records has NOT been officially requested. Please update your billers so these services are NOT prematurely written off.

Submit the claims, records, and denial of insufficient records for reprocessing.

Thank you

Arizona Providers – CAQH

The state of Arizona does not issue a Controlled Dangerous Substance (CDS) certificate and Arizona Controlled Substances Prescription Monitoring Program registration information should not be entered in the CDS field.
Therefore, when completing your application or attesting in CAQH ProView, please select ‘No’ as the response to the following question:
Controlled Dangerous Substance (CDS) Registration
Do you have a CDS Registration Certificate?
By answering ‘No’ to this question you will not be required to enter a CDS number, expiration date, and you will not be required to submit a document.
If you have questions regarding this communication please contact the CAQH ProView Help Desk by chat or you may call: 1-888-599-1771.
Thank you.