Billing Medicare
Answered
I'm new to (doing my own) billing and have a question when submitting to Medicare. On the CMS1500 form, on line 24f (Charges), do I input my charge/fee or the Medicare allowable rate? It appears the Simple Practice software automatically enters my (full) rates. Will Medicare simply pay the allowable?
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Hi Beverly, I'd be happy to help with your question. When billing Medicare or any other insurance payer, you'll always want to input your full fee. The insurance payer will pay the allowable rate, and you'll be able to write off the different when you enter the insurance payment. Let me know if you have any additional questions about this, or anything else SimplePractice. I'm here to help.
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I am not allowed to be credentialed with Medicare (my license is not accepted), so I do not have a PTAN. My question is I have a client that has Medicare as primary and Medicaid as secondary (which I do take), how do I bill Medicare (and get denied) so that I can bill Medicaid as secondary?
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Hi Theodore, I've had to set up my billing Medicare through SP recently. I went to "Settings" and then to the Insurance section and went the Medicare payer, according to your state. For me being in Texas I went to Medicare Part B of Texas. Then you click on "enroll" for "Claim filing enrollment" (to file claims electronically and also enrolled for the "Payer Form Enrollment" to ensure you get the EOB upon payment/processing of the claim. When you enroll, you will also be prompted to give your PTAN. Just FYI: It took about a month or so for these enrollments to go through. So you can file claims through mail in the meantime or create a claim for all DOS's once your enrollment has gone through. I hope that this helps!
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Hi Rose, I'd recommend checking to see what information you're credentialed under with the insurance payer directly. Then your Settings > Insurance > Enrollments to see if you're enrolled under your Group Practice NPI, Tax ID and Billing information. Make sure your enrollment information matches the information you were credentialled with. If the two are different, or the Billing information on your claim doesn't reflect both, this could explain why your claims are getting denied. For more insight, you can submit an email Help Request to our Insurance Team.
Theodore, I'd recommend going to your Settings > Insurance > Enrollments page and clicking on the +Enroll button to enroll for each payer you bill. You can enroll for electronic claims filing and receiving ERAs through SimplePractice. If you've already done this, but ran into issues, I'd also recommend reaching out to our Insurance Team by submitting a Help Request.
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Has any one successfully billed Medicare with SP ?
it seems that this is an issue for many users and has been for me. I end up getting frustrated and set it aside because I'm very busy . Paying for a separate biller for too long which is time consuming. I'm wondering if I need to look at other options? there really needs to be clearer support for this issue which has been an issue for years.
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I've been accepted to become a Medicare provider part B for Illinois. How do I set this up in Simple Practice? When I utilize payer ID of 06102, it lists a billing address of a PO box in Texas, and I don't know if these claims will get to where they need to go.
On Medicare's end, I was directed to submit EDI (electronic data interchange) registration. They are asking for Simple Practice's trading partner ID, address, and contact. Do I need to do this AS WELL as enroll within Simple Practice?
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