Anyone ever do Medicaid/Medicare billing as a business?

**clovis** · #1 01/01/05, 08:53 PM

I have a cousin that started a business billing for Medicaid and Medicare for nursing homes. My understanding is that some treatments, procedures and products that certain patients use can be billed to Medicare and Medicaid, but the paperwork is enormous and a huge mess.
My cousin now does this paperwork and billing for the nursing homes, and is getting half of the payment for their work. The nursing homes are happy because this is money that they would have never recieved since the billing is too complicated.
They told me that they are making more money at this than in their real jobs, but cannot afford to quit because of their health insurance situation. I have no reason to doubt them in their claim of new found wealth. They are very down to earth folks, and I have always found them to be very honest.
I have thought about asking them for a sales job on a part time basis, covering areas that they cannot cover. But on second thought, I would like to study this in order to learn if I could just do this on my own, which would allow my wife to quit her job.
My wife and I are both at a crossroads in our lives with careers, so ANY help you could offer, is greatly appreciated!
clove

inc · #2 01/01/05, 08:58 PM

i desperately need something like this too- if only i could get teh words and numbers to line up, ever agian.
good luck and i wish i knew of someone to help you

Mary in MO · #3 01/02/05, 07:42 AM

Clove,
I do billing for a therapist - Medicaid and some private pays. It's for therapy so the codes are easier. Medical billing can be VERY hairy and complicated. I get 10% of the amount paid (which is about half of what is billed after the gov. does it's deductions). I make about $150 for about 2 hours work each month. Not a major amount, but enough to help out. I worked in medical records before and understand the process, ICD, CPT codes etc. I happened to work with this therapist a long time ago when I worked with the state department of mental health. I was the financial resource officer then. She went into private practice and approached me.

It can be a very good business. Do remember that you are liable/responsible for billing irregularities and your coding has to be on the mark. If you get the bills with the codes there already you're more than half the way thru. That's the hardest part. What I do involves just a handful of codes. You use a form called a HCFA and there are two parts for codes. The first is diagnoses the second is procedure. Each "insurance" may pay differently for the same thing, i.e. 30 minutes for and assessment to be billed in 2 units or 60 minutes to be billed in 1 unit of service. The pain is when you have to code differently for different "insurances" i.e., Medicaid, Mercy, MC+ etc... Some require the same procedure to be coded differently and different modifiers to be included. Most of my mistakes are really stupid ones, like forgetting to mark the sex or not getting a pre-auth number or the pre-auth changed and I wasn't informed. Medicare is a whole nother animal I haven't dealt with. I talked to ladies who managed some of the Medicare billing for one of our hospitals and it sounds like a BEAR. It will require quite a bit of study on your part and frequent checks on your state and medicaid's billing websites for updates and changes in procedures. As a matter of fact, I have a stack waiting to be done now I've put off from earlier this month - make that last month. After coffee I start in on it.

When you're doing a business on your own the hardest part is drumming up the clients. Sounds like that part of the hurdle is non-existant for you. I'd ask pointed questions and feel free to ask me for any clarification. I work in a hospital now, but am in clinical regulatory.

I read the board most every day and have lurked for quite a few years. Don't post much, every once in a while.

Mary

pamda · #4 01/02/05, 09:53 AM

I just finished a course to become a medical assistant and part of it was billing. All the codes you would need are in books and can be purchached (sp). The books are pricy and the chart is huge but easy to read. The clinic I externed in had them in every nurses station.

DreamingBig · #5 01/02/05, 04:08 PM

Well, I'll post what a coder friend of mine had to say on this. She says:

The first thing that comes to mind is that to state it
like that ("getting half the payment for their work")
is an open admission of a federal felony. If this is
someone you know, you might want to advise them to be
a little more circumspect about the payment
arrangements.

In my own experience, most nursing homes just hire
staff billers with Medicare/Medicaid experience,
although there are definitely some that subcontract it
(I would have serious misgivings about any that would
subcontract to an individual by offering "half the
payment," though, as that would be pretty irregular).
Many doctors' offices subcontract billing, as well.

Medical billing is a specialty of its own, like
medical transcription or coding (see
www.ambanet.net/AMBA.htm). As such, there are a
variety of training programs, both online and through
community or technical colleges.

I am not aware of any billers making unusually big
money at it, but that certainly doesn't mean there
aren't some who are. I know a couple billers and
their effort to income ratio is about average.

moonrunner357 · #6 01/02/05, 04:37 PM

Does medicare/medicade and insurance bills for 2004 have to be submitted by Dec 31 of 2004? Or can they be submitted on into 2005?

**clovis** · #7 01/02/05, 08:13 PM

Thank you everyone for your responses!

I hadn't checked the site today for responses because I didn't think anyone would know what I was talking about!

This business is for very specialized Medicare billing only, which most nursing homes don't file claims, but are due payment. I would like to learn more about this as a business opportunity.

Keep the responses coming!

clove

**clovis** · #8 01/02/05, 08:14 PM

Mary,
Can I pm you tomarrow with some questions?
clove

Mary in MO · #9 01/03/05, 08:31 PM

Quote:

Originally Posted by clovis

Mary,
Can I pm you tomarrow with some questions?
clove

No problem, sageladyoneatnospamyahooyouknowthe rest.
Mary

flutemandolin · #10 01/04/05, 08:50 AM

There is a business located just a few miles from my home that specializes in just what you are describing. The owners deliberately located it here in this low-income county to provide job opportunities for people in the community, without having to commute to the city. They have accounts with public hospitals in some of the largest counties in the U.S.

That said, the operation is very technology-intense. They have a staff of computer programmers who developed special software unique to each account. A lot of it is automated, but then everything needs to be verified by hand. I worked there for a while, but not long enough to know much about the entire process, or what percent they made off each successful transaction. They seemed to be doing okay though. They provided some of the best insurance benefits in the area!