Home Forums Discussions Coding and Billing Electronic billing for pediatrics, mainly medicaid practice

I have been using AC for 1.5 years now, still print the HCFA 1500 and submit via paper, the practice has build up and now i am looking for electronic billing, here is my practice scenario
1. predomninantly medicaid practice in Texas, very few private pay
2.The AC still does not have the sequintial billing for entering vaccines, so have to still maually modify the HFCA 1500 , before submission, is there a company who would be able to scrub and forward the encounters properly for shots
I want to check if some has experience with Pediatrics /medicaid population and what electronic billing company would they recommend - Office Ally , EZ claim , medisoft
( most of the paper claims i submit are paid properly by medicaid HMO, so i dont know if its worth paying a company 4-8% of gross , when 90% of the claims are paid properly and dont need help

Why change what works.

Figure out how much time your staff spends doing billing and calculate a percentage.

Office Ally did not connect with IL Medicaid and they were blaming each other. I was going to go through EZ Claim but since it did not work I went through another company (MTBC, which I do not recommend but it is working)

I do not have the issue about having to separately put the 90641's with each vaccine. Since they are paid by VFC, they use the vaccine code and pay a fee. They do not recognize 90641.

I have been and continue to wait for V7, hopefully one of these days.

Thanks for the reply, The system has worked for me but i have to be involved in the process, so that is an extra stress and usually i get backed up , right now i have 1 month worth of billing to print and check before I send it , rejection rate is minimal , but still stress.
I am not sure if any one has experience with office ally from texas
I believe you are talking about
90460 and 90461 ( code for the first and second vaccine component) , when i give two of more shots to any one , i have to manually alter and correct the hcfa 1500 before sending it , so was trying to check if office ally is able to scrub the hcfa 1500 and send it the way the texas medicaid hmo need it/accept it !!!

Yes Speaking about V7 is there any insight.... Smoke from the Chimney in Rome or what have you as to how all of that is going and how long that is going to take???? Again....

For those of us who first brough this up I believe back in like 2006 or so, this is like Groundhogs Day at this point.... Sure, Yes we get it, yes we do intend to add a real fiscal and practice managment program that works smoothly side to side with original AC the EMR.....

What are we on now, like the sixth year or something like that??? What day is it again????

It's coming, it's coming, hopefully soon .......

feibax,
We are in the same situation - 90% medicaid and medicaid HMOs. We also print claims on 1500 forms but not from AC. We use TotalMD. There is a link between AC and TotalMD. When a note is saved, the CPT codes selected by the doctor show up in the TotalMD ledger.

However, the doctor does not select the vaccine codes in AC as this would take her too long. The MA selects the vaccine codes on a paper superbill. So when we have a checkup encounter, an MA fills out the vaccines on a paper superbill and does the triage in AC. She forwards the note to the doctor. The doctor opens the note and looks at the paper superbill while seeing the patient. When she is done with the patient, she selects the checkup code in AC and reviews the paper superbill to make sure the right vaccines were selected (in case the patient doesn't want one of the vaccines or maybe he spit out all the rotavirus, etc.)

When we do billing, we take the paper superbill and open up TotalMD. We find the encounter date written on the superbill and find this date in TotalMD. Then we manually enter all the vaccine and admin codes to create the claim.

We still have a problem with some HMOs - Amerigroup, Molina and UHC. When we give more than 2 vaccines, the claim has 2 pages. They won't pay the 90460 and 90461 on the 2nd page of the claim because it's a "duplicate" of the admin codes on the 1st page. Even when I put the grand total on both pages they still process them as 2 claims.

Oh I also tried to use TotalMD with Gateway EDI but TotalMD's electronic claim is actually only an "image" of the 1500 form, so anything over 1 page still looks like 2 claims. I don't know if all billing software does this or just TotalMD.

I don't have a solution yet aside from phasing out those problematic HMOs. We've already stopped taking new patients with Amerigroup and Molina. UHC has a provider rep so I'm working with them to correct this problem.

What do you do when you have 2 pages with in a claim with 90460 on both pages?

Serene

I'm not quite sure why it would take so long. It takes me about 5 seconds to select the codes.
In the "quick pick" section, I have coded the vaccines so the are next to each other thus
101 Pediatrix, 102 HiB, 103 Prevnar, 104 Rotavirus. Thus I just click the 4 boxes along with anything else and billing only takes a few seconds. All of the vaccines are together, labs are together (800 series codes) and procedures (600 series codes). I picked this method up from another AC user, but even before that it really only took less than 30 seconds to find the codes.

Wendell, I guess that is true, but the biller would still have to add the admin codes anyway. We have to add each admin code after each vaccine. The only way to do this is to manually edit the ledger/claim in our billing program. Maybe we bought the wrong billing software, but in TotalMD I cannot just add a 90460 and move it to the right line. I would have to delete the all the vaccine codes and add them and the admin codes back in the right order.

We could have her select the vaccines for private insurance since they don't have this silly vaccine sequencing requirement. This Texas Medicaid requirement is the root of 90% of our billing problems!

my issue with AC IS TO DO WITH SEQUENTIAL DOING
TAKE FOR EXAMPLE THE 2 MONTHS SHOTS I GIVE PENTACEL/ROTA/PCV AND HEP b
THE ISSURANCE COMPANIES WANT THE HFCA TO SHOW
90698
90460 1UNIT
90461 4UNITS
90670
90460 1 UNIT
90744
90460 1UNIT
90680
90460 1UNIT
( BUT WITH AC ,WHAT HAPPENS IS THAT WHENEVER THE INPUT WILL BE DONE , IT WILL SHOW AS BELOW)
90698
90460 4 UNITS( IT WILL BUNDLE ALL TOGETHER)
90461 4 UNITS
90670
90744
90680
THIS IS NOT ACCEPTED BY INSURANCES AND I HAVE TO MANUALLY CORRECT THEM TO THE SEQUENTIAL CODING , SO I CAN GET PAID, SO I AM LOOKING FOR AC TO CHANGE THIS OR HAVE A PM SOFTWARE TO MODIFY IT
SERENE -- FOR THE SECOND PAGE I DO IT MANUALLY IN A WAY THAT EVEN IF THEY SEPARATE THE SECOND PAGE , IT STILL CAN GET PAID
EITHER WAY SINCE THE SHOTS A SUCH A BIG COMPONENT FOR PEDS , AC SHOULD QUICKLY FIND WAY TO MODIFY IT
-WENDELL GOOD IDEA ABOUT QUICK PIC BUT STILL DOE NOT SOLVE THE SEQUENTIAL BILLING ISSUE

feibax,
I've contacted AC about this sequential issue but did not get a reply. Also, there's no option to have custom modifiers so we would have to manually put in the AM modifier for medicaid claims. I think AC is not a good solution for billing Texas Medicaid right now.