Wiki Student with a question on billing insurance

[HRT216]

I am a student in the medical billing and coding field and I am reaching out to you today to see if anyone can help me answer some questions. I have been trying to research but I can't seem to find the answers I am looking for.

I work for a non profit that connects cancer patients to resources that help their individual situations. If they need financial/support/food etc we provide them resources to help with their needs free of cost. We also do patient advocate services and attend oncology appointments with patients and call monthly to check in on them and see how they are or if they have any new needs. Right now I am trying my hardest to find out if we can bill for our services. From what I understand so far we cannot bill insurance because none of us have medical credentials.

My questions are:

Is there a difference in billing insurance when the medical professional is certified compared to licensed, or is it the same? For example, if we wanted to bill insurance for accompanying a patient to an oncology appointment would it have to be a licensed nurse that goes to the appointment to make it billable or could it be a certified medical assistance or STNA/CNA. Or if we had a social worker on staff would we be able to bill for care coordination or anything like that?

Any help with these questions would be greatly appreciated! Thank you in advance and have a nice day everyone.

 

[SharonCollachi]

You need to have licensed personnel, and they may have to work under other licensed personnel (like an MD).

 

[sls314]

You need to have licensed personnel, and they may have to work under other licensed personnel (like an MD).

And on top of that, the service would have to be a covered benefit on the patient's plan to be reimbursed. I don't think that having someone accompany a patient to a medical appointment would typically be a covered benefit under most health insurance plans.

(I'll look into whether Medicaid might cover anything like that - there's a better shot with that than any commercial insurance plan around here. I'm already pretty familiar with the Ohio Medicaid website, so it wouldn't be too much trouble to poke around & see.)

P.S. OP, I am in the same area as you. Please feel free to join our chapter Facebook group if you haven't already. You'll see announcements about our chapter meetings and events, in addition to other information: https://www.facebook.com/groups/2180189195636391

 

[HRT216]

And on top of that, the service would have to be a covered benefit on the patient's plan to be reimbursed. I don't think that having someone accompany a patient to a medical appointment would typically be a covered benefit under most health insurance plans.

(I'll look into whether Medicaid might cover anything like that - there's a better shot with that than any commercial insurance plan around here. I'm already pretty familiar with the Ohio Medicaid website, so it wouldn't be too much trouble to poke around & see.)

P.S. OP, I am in the same area as you. Please feel free to join our chapter Facebook group if you haven't already. You'll see announcements about our chapter meetings and events, in addition to other information: https://www.facebook.com/groups/2180189195636391

Thank you so much! That would be super aweomse! I did join the facebook group too. On my way to trying to get certified but its really intimidating! I think my boss is looking to add a social worker to our staff and since we are a non profit we are always looking for ways to fund our purpose. (Which is helping cancer patients in our community so if you know anyone in the Toledo or surrounding areas that may benefit from free services let them know about us! Cancer Connection of NW Ohio) I really appreciate your help. This stuff can get pretty confusing when you are newer to it.

 

[HRT216]

And on top of that, the service would have to be a covered benefit on the patient's plan to be reimbursed. I don't think that having someone accompany a patient to a medical appointment would typically be a covered benefit under most health insurance plans.

(I'll look into whether Medicaid might cover anything like that - there's a better shot with that than any commercial insurance plan around here. I'm already pretty familiar with the Ohio Medicaid website, so it wouldn't be too much trouble to poke around & see.)

P.S. OP, I am in the same area as you. Please feel free to join our chapter Facebook group if you haven't already. You'll see announcements about our chapter meetings and events, in addition to other information: https://www.facebook.com/groups/2180189195636391

You need to have licensed personnel, and they may have to work under other licensed personnel (like an MD).

Thank you!