Overview Creating a Bill and Billing Manual

Objectives Review the Credentialing Process Setting up the Practice Management Systems Items to Consider in Creating a Billing Manual

Considerations Before You Start Billing Know your State requirements Incorporate, obtain Tax ID, and bank account Obtain Insurance Coverage Seek legal counsel

Credentialing Vetting Process NCQA Standards for Payers

Credentialing with Insurance Companies First Step negotiate terms of contract Complete Insurance Companies credentialing form Pitfalls to avoid

National Provider Identifier (NPI) NPI number is needed before a provider can apply to Medicare NPI Application SEPARATE from Medicare enrollment Apply on-line: Contact Info: NPI Enumerator is Fox Systems call or

Provider Enrollment, Chain, and Ownerships System (PECOS) What is PECOS What You Need to use PECOS pEnroll/Downloads/PECOSWebScreenE xample.pdfhttp:// pEnroll/Downloads/PECOSWebScreenE xample.pdf

Credentialing with Medicare/Medicaid Medicare Form 855 Medicaid Forms vary from State to State NPI number is need before applying to Medicare

Setting up Your Practice Management System (PMS) Selection of PMS product Insurance Contracts Electronic Data Interchange Encounter Forms

Selecting a Practice Management System Secure technical expertise if needed Consider other alternatives Research, Research, Research Get all sales pitch promises written into the contract

Insurance Contracts Have a current listing of all accepted Insurance Plans Set up each payer fee schedule in your PMS Add any special rules in your PMS

Electronic Data Interchange (EDI) Advantages of EDI Clearinghouse Number One Goal Clean Claim submission on first attempt

Billing Manual Policies and Procedures Before you do anything: –Know your compliance requirements –Know requirements by payers –Know the capabilities of your PMS

Billing Manual Policies and Procedures –Compliance requirements should be incorporated in policies –Job Descriptions included –Don’t forget to take into consideration the patient experience

Billing Manual Ensure the Billing manual is a “live” document –Review the manual regularly –Train staff to perform consistent with procedures –Make sure appropriate internal controls are included

Questions? Gervean Williams Director of Finance and Operations National Association of Community Health Centers