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Thread: hh peds ofc billing only c/a to all insurances?!

  1. #1
    Join Date
    Apr 2007

    Default hh peds ofc billing only c/a to all insurances?!

    AAPC: Back to School
    I just recently accept a p/t billing position with a home health pediatrics company...I have only been there 1 week and already have tons of questions of how they are doing business. I have over 10 years medical billing and need someone else to let me know if I am totally wrong in questioning this company (7 year company owned by nurse/husband team).
    They are billing only the C/A accepted by the insurances they contract with. I was under the impression we must bill the total charge, then do the c/a if needed and bal bill patient for coinsurance/copay/deductible if needed...
    I was told by there office mgr and the owner of the company they do not want to do c/a's as that would take forever and he wants to know what revenue is coming in the door (actual $ amount). So for example, Anthem allows $95 for skilled nursing visit, that is what is billed on the UB04.
    Am I wrong to speak up and say that doing c/a's is just part of doing billing...I believe they desperately need a new computer software system and some more education on how they are to bill.
    How do I tell them in a nice manner that they are not billing correctly???
    ***Also, they do not bill for SN Assessments ---they do bill assessments but only for 1 insurance??? That doesn't make since to me...
    I feel they could be loosing TONS of money billing this way...
    I love the p/t hours but its really hard to not care about my work and do things the way they think they need to be done.
    Please HELP, need guidance on what to do???
    Thanks in advance for your help.

  2. #2


    Hi Angela,

    Just to make sure I'm understanding you correctly...they are billing different amounts to each insurance company according to the allowables in the contracts? Also, they are only billing SN visits to one insurance company...did they say why? This sounds very suspicous. You're correct, adjustments are a part of doing business. Are they also doing this with Medicare and Medicaid patients also?

    Sorry for all of the questions, but I would like to help do some research on it to help you, but want to make sure that I am understanding your post correctly.

  3. #3
    Join Date
    Apr 2007


    Yes, they are billing different amounts to each insurance company...billing the contracted allowables only.
    They bill SN visits to all insurances when done but they don't bill Skilled Nursing Assessments but to 1 insurance for some reason??? Never got straight answer on as the reason why.
    Since this is Home Health Agency for Piediatrics only -they do not par w/ Medicare. They only par for straight VA Medicaid billing DME only...they can't bill SN visits for straight VA Medicaid patient's as I was told by office mgr they would have to have PT, OT, ST on staff available for the patient's and they do not contract with anyone in order to staff those other disciplines.
    Thanks for all your help...I am one to question things if I don't understand and I don't want them to think I am trying to change the way they do business but I want to provide them with the correct info so it can be done tactfully I guess you would say...

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