Medicare Claims

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kybiller
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Joined: Tue Aug 04, 2009 5:49 pm

Medicare Claims

Post by kybiller » Thu Aug 22, 2013 8:45 pm

I have a provider in Massachusetts. I can file almost all of his claims for free and quite easily online via the web with the few insurers he deals with such as UBH, Beacon, MBHP (Value Options). The only one we still send on paper is Medicare. I can use a clearing house but he doesn't want to pay for it. We are seeing costs of $55/mo and up. Mailing his Medicare claims costs about $1.50/mo. I talked with Medicare Massachusetts and the other option is to download their free software and submit via modem. I don't have a modem. Does anyone anymore? They said "Medicare doesn't trust the web". Well OK. Am I stuck with paper? :(

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Gavin Walker
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Re: Medicare Claims

Post by Gavin Walker » Fri Aug 23, 2013 3:57 pm

There are two ways to look at this.

1. Sign up with a clearinghouse and submit ALL of your claims in a single batch all at once every day. The $55/month can be a bargain once you factor in all the time you spend at each payer's website and the time spent enrolling with each of them and the changes you will have to deal with at each website including password changes, etc. Especially in light of ICD-10, you should test at each site that you are ready for ICD-10.

2. FREE is the best option for you and you have time to deal with each payer's website, including double entry if necessary. This includes setup and training on how to submit claims to each payer. Commercial carriers that only work with clearinghouses will have to be printed on paper.

If you go with option #1, then RelayHealth is currently $50/month/provider for electronic claims. We provide FREE setup for RelayHealth if you enroll under us and you are on Medisoft v17 or higher. If you go with option #2, then I suggest waiting until your Medicare Intermediary switches to National Government Services in October. If you setup now under NHIC, then you get to do it all over again with NGS. If you utilize us to set this up for you, then we charge $150 to setup the first practice to submit to NGS if you are on Medisoft v17 or higher. You will need to utilize a third-party secure FTP client such as Filezilla (free) to upload your claim files to NGS.
Gavin Walker
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kybiller
Posts: 20
Joined: Tue Aug 04, 2009 5:49 pm

Re: Medicare Claims - and Clearinghouse

Post by kybiller » Fri Oct 04, 2013 10:23 am

I currently work with 9 independent providers. So far I have one interested in the clearinghouse. She is my largest client so that's a great start. There are 3 that I only spend a few minutes a week on who will not likely want to spend more than they currently are. I'd like to get the other 5 signed up for the clearinghouse so I'll work on that. How much work is involved? Is it a problem to have some who will use the clearinghouse and others who will not? How long does it take to switch over to this method? On the Medicare issue, of my providers only 3 submit Medicare claims. One submits about 24/month and the other 2 have only a couple of pts on Medicare and submit a few claims a month to Medicare.

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Gavin Walker
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Re: Medicare Claims

Post by Gavin Walker » Fri Oct 04, 2013 10:46 am

I assume the 1 provider is setup in a separate Medisoft practice from the other providers. It is not a problem to setup just one practice to send to a clearinghouse while you continue to use the manual process on the other practices.

If you have several low volume providers, then Availity Advanced Clearinghouse Services might be a fit. If you setup under us, then the setup is FREE and then we charge $58.50/month for up to 300 claims. Each additional 300 claims is $58.50.

kybiller
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Re: Medicare Claims

Post by kybiller » Fri Oct 04, 2013 11:16 am

I like that idea for the smaller practices. I'm talking with each practice and will get back to you on how many I can bring to the clearinghouse idea.

lovehearing
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Joined: Thu Oct 27, 2016 4:15 pm

Re: Medicare Claims

Post by lovehearing » Thu Oct 27, 2016 4:59 pm

Hi Mr. Gavin Walker,

How do I print second insurance on the cms 1500 while Medicare is the primary. How do I click yes on line 11d. I believe I did everything correct but the second insurance info just won't show. I'm doing paper claim. Thank you very much.

Emily

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Gavin Walker
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Re: Medicare Claims

Post by Gavin Walker » Sat Oct 29, 2016 10:35 am

Which claim report template are you using? CMS-1500 (Primary) - 02/12?

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