Maximizing Reimbursement: Navigating The Asq Billing And Insurance Process

Billing insurance for ASQ-3, the Ages and Stages Questionnaire, is a process that can be undertaken by medical practitioners to ensure they are reimbursed for developmental screenings. ASQ-3 is a developmental screening tool that is used during well-child visits at 4, 9, 18 and 24-month checkups. It is important to note that billing insurance for ASQ-3 is applicable for Medicaid and many private insurance companies. The billing code for this service is 96110. When billing insurance for ASQ-3, it is crucial to be aware of the patient's insurance coverage and the coordination of benefits (COB) between different policies.

ASQ-3 and MCHAT screenings for children qualify for 96110 billing to Medicaid and private insurance companies

ASQ-3 and MCHAT screenings for children can be billed to Medicaid and private insurance companies using the CPT code 96110. This code covers the administration of a developmental screening tool, such as a questionnaire or survey, which is completed by a parent or caregiver and then scored and interpreted by a healthcare professional.

The CPT code 96110 is specifically for "developmental screening (e.g. developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument". It is important to note that this code does not represent physician work but is instead valued based on practice expense and professional liability. The physician's interpretation of the score is considered part of the evaluation and management (E/M) service, which would be billed in addition to the screening code.

For patients with Medicaid, CPT code 96110 can be billed in addition to other CPT codes such as evaluation and management (E&M) codes or preventive visit codes (e.g. well-child visits/child health checkups). As of 2009, Medicaid in Oklahoma reimbursed $9.30 per instance of 96110. For patients with private insurance, it is necessary to check with the payor to determine their reimbursement policy for 96110.

When billing for ASQ-3 and MCHAT screenings, it is important to document that the screening was administered and to note any follow-up actions taken, such as referral to a community agency or resource. Additionally, most payers allow for a maximum of two units per date of service for code 96110.

By correctly coding and billing for these screenings, healthcare providers can ensure they are maximizing their revenue and providing valuable developmental screening services for children.

If a patient has more than one insurance plan, confirm which is primary coverage before submitting a claim

If a patient has more than one insurance plan, it is crucial to confirm which plan is their primary coverage before submitting a claim. Healthcare providers cannot submit a claim to multiple insurance companies simultaneously. Instead, the claim must first be submitted to the primary insurer, and then, if there is still a balance, to the secondary insurer.

The primary insurance is the plan that will pay out first, and the secondary insurance will only pay out if the primary insurance does not cover the entire bill. To determine which insurance is primary and which is secondary, you need to check the coordination of benefits (COB). This is a provision in an insurance policy that specifies what each insurer is responsible for paying. While there are various rules and variables that can affect which insurer is the primary payer, there are some general standards to be aware of:

• Typically, a patient's coverage from their own employer will be their primary insurance, and their coverage from a spouse or parent will be secondary.
• If a patient has both Medicare and employer coverage, the employer-based insurance pays first, as long as the company has 20 or more employees. If it's a smaller business, Medicare pays first.
• For children or young adults under 26 who are covered by both parents' insurance plans, there is a "birthday rule" that applies. The parent whose birthday falls first in the calendar year has the primary insurance plan, and the other parent's insurance is secondary.
• If parents are divorced, there may be a court order to determine which insurance plan is primary. If there is no court order, the birthday rule applies.
• If one parent is covered under COBRA, the other insurance plan will always be primary.
• If a young adult under 26 is married and covered by both a parent and a spouse, the plan that has been effective longer is primary. If the plans started on the same day, the birthday rule applies. However, if the young adult is covered by their employer, that coverage is primary, and their parent/spouse's coverage is secondary.

It is important to confirm the COB before submitting a claim to secondary insurance. Claims submitted in the wrong order are more likely to be denied, causing delays and additional work for your billing team.

If a patient is covered by two policies, submit a claim to the second payer if there's a balance after the primary policy has paid

Billing insurance for patients can be a complex process, especially when a patient has multiple insurance plans. In such cases, it is crucial to understand the difference between primary and secondary insurance coverage. Primary insurance is typically provided by an employer and is considered the main coverage. On the other hand, secondary insurance is an additional plan that a patient may have, such as a government plan like Medicare, Medicaid, or TRICARE, or insurance obtained through a spouse or parent.

When a patient has two insurance policies, determining the coordination of benefits (COB) is essential. The COB outlines the responsibilities of each insurer and specifies which insurer is the primary payer. In most cases, a patient's coverage from their employer will be the primary insurance, while coverage from a spouse or parent will be secondary. However, there may be exceptions, so it is important to confirm the COB with the patient or the insurance companies.

When billing for a patient with two policies, the claim must first be submitted to the primary insurance. After the primary insurance has paid their portion, if there is still a balance remaining, the claim can then be submitted to the secondary insurance company. It is important to note that both insurance companies cannot be billed at the same time. The secondary insurance company will require information such as the total amount billed, the amount paid by the primary insurer, and an explanation of why the primary insurer did not cover the full amount.

It is worth mentioning that having two insurance plans does not necessarily mean the patient has no payment responsibility. The secondary insurance may not cover certain expenses, such as the primary insurance's deductible, copays, or coinsurance. Therefore, patients may still have some out-of-pocket expenses even with multiple insurance plans.

In conclusion, when billing insurance for a patient with two policies, it is important to follow these steps: verify the COB, bill the primary insurance first, and then submit a claim to the secondary insurance if there is still a balance remaining. By following these steps, medical practices can ensure they receive proper reimbursement and reduce the risk of claim denials.

When billing a secondary payer, include the total billed, how much the primary insurer paid, and why the full balance wasn't paid

When a patient has multiple insurance plans, billing can become more complex. In such cases, one plan is considered the primary insurance, and the other is the secondary insurance. The primary insurance pays out first, and the secondary insurance covers some or all of the remaining balance. It's important to note that the patient may still have payment responsibility even with two insurance plans.

When billing a secondary payer, it's crucial to include specific details to ensure a seamless process and avoid claim denials. In addition to the regular billing information, you must provide the following:

• The total amount billed initially
• The amount paid by the primary insurer
• The reasons why the primary insurer didn't pay the full balance or the remaining balance
• Any adjustments and categories for the remaining balance
• The remittance information and explanation of benefits (EOB) from the primary insurer

By including these details, you provide the secondary insurer with a clear understanding of the primary insurer's actions and the outstanding amount. This helps prevent claim denials and streamlines the billing process.

Additionally, it's essential to confirm the coordination of benefits (COB) before submitting a secondary insurance claim. The COB specifies each insurer's responsibilities and helps determine which plan is primary and which is secondary. Usually, a patient's coverage from their employer is the primary insurance, while coverage from a spouse or parent is secondary. However, there may be exceptions, so it's always best to verify with the patient or the insurance companies directly.

Using a claims clearinghouse can save time and streamline the process by catching errors before submitting a claim

Medical billing is often a complicated and time-consuming process. A claims clearinghouse can help to streamline the process by checking claims for errors, storing detailed information on each claim, and enabling electronic funds transfer (EFT) payments. As a result, more claims are paid on time, and less time is wasted on preventable misunderstandings.

When healthcare providers install medical billing software, each claim becomes a file known as an ANSI-X12-837. Each file is then uploaded to the clearinghouse and “scrubbed” for errors. Finally, the error-free file is transmitted to the insurance company for processing. This entire process takes place over secure electronic connections per the guidelines of the Health Insurance Portability and Accountability Act (HIPAA).

A clearinghouse will review and check claims for errors before submitting them to the payer. If there is an issue, the system will let you know so you can fix it before resubmitting. This can save time and streamline your process, especially with secondary claims, which require some extra information. For example, if you tried to submit a secondary insurance claim without adding the amount the primary insurance paid, the clearinghouse would flag that omission before sending in the claim.

Clearinghouses are intended to serve as a middleman between providers and insurers, capable of handling and securely sending billions of claims electronically. They are aggregators (senders and receivers) of electronic claim information, managed by software. They also offer medical billers and billing managers a way to consolidate all their electronic claims and manage them from a single location, from an online dashboard control panel, similar to online checking.

The average error rate for paper claims is 28%. But using the right clearinghouse can reduce that to 2-3%.

Frequently asked questions