Guest guest Posted March 31, 2009 Report Share Posted March 31, 2009 Hi everyone, can someone send me a sample of the form that you use in your office that you give your patients so they can send that to their health insurance? I would really appreciate it. One of my patients asked me to give them a form like that and I have not done that before. Thanks Yuliya Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2009 Report Share Posted March 31, 2009 Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - Yuliya Goldberg Chinese Medicine Monday, March 30, 2009 5:18 PM insurance form Hi everyone, can someone send me a sample of the form that you use in your office that you give your patients so they can send that to their health insurance? I would really appreciate it. One of my patients asked me to give them a form like that and I have not done that before. Thanks Yuliya Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2009 Report Share Posted March 31, 2009 I don't know of a form that can be modified, I only have the pdf. You can print out the pdf, enter your personal info, when the client comes in, you ask them to enter their personal info on top, then you copy it, and keep the blank in their file, whenever they come in for treatments, you just enter the date, the treatment code, and the diagnosis code. Cross out the blank area, so the form cannot be altered after it leaves your office (A former client of mine attempted that, it was a big mess because my signature was on the form.) Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - Yuliya Goldberg Chinese Medicine Monday, March 30, 2009 5:18 PM insurance form Hi everyone, can someone send me a sample of the form that you use in your office that you give your patients so they can send that to their health insurance? I would really appreciate it. One of my patients asked me to give them a form like that and I have not done that before. Thanks Yuliya Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2009 Report Share Posted March 31, 2009 Why not just use the standard CMS 1500 (formerly HCFA 1500) form and simply check no in the box for accepting assignment, then the payment goes to the patient? There is a fillable form of this on the net that I have recommended and know is being used by other LAc's. The beauty of this is that it is then easy to read, as it is typed and cannot be changed. Print two copies, one for patient and one for their file, and you are done. Much easier to read then hand-written notes. BTW, as we move more toward electronic claim submissions, how are you and/or the patient planning to deal with this as you will be required to send it online? Just curious as that is rapidly approaching for us in MN. Michael W. Bowser, LAc Chinese Medicine angelapfa Mon, 30 Mar 2009 17:48:52 -0700 Re: insurance form I don't know of a form that can be modified, I only have the pdf. You can print out the pdf, enter your personal info, when the client comes in, you ask them to enter their personal info on top, then you copy it, and keep the blank in their file, whenever they come in for treatments, you just enter the date, the treatment code, and the diagnosis code. Cross out the blank area, so the form cannot be altered after it leaves your office (A former client of mine attempted that, it was a big mess because my signature was on the form.) Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - Yuliya Goldberg Chinese Medicine Monday, March 30, 2009 5:18 PM insurance form Hi everyone, can someone send me a sample of the form that you use in your office that you give your patients so they can send that to their health insurance? I would really appreciate it. One of my patients asked me to give them a form like that and I have not done that before. Thanks Yuliya Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2009 Report Share Posted March 31, 2009 you're basically asking for a superbill, that you make listing the diagnosis & procedure codes, with fees. You need you tax-id/ss# (rec. #1 due to fraud), license #, & signature, with a space for the patient's name, address, insurance info, for them to fill in and send to the insurance. You'll need a reference for codes, however. It could be as simple as this: provider name, L.Ac. address Telephone: e-mail: FEE SLIP Patient Name, SS# Address Phone Insurance Co. Policy No. Group No. Date of Service Diagnosis Code Procedure code Fee Other ( ) Fee for herbs: $ ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬signed your name, L.Ac. Provider Tax ID No. Lic. No. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted March 31, 2009 Report Share Posted March 31, 2009 I attached the pdf to my last post but the list stripped it, if you want the form, just send me your email address, I do mean the 1500 form. I don't know of a version of it that can be modified on the net, if you do, please post the link. I did electronic billing, and it's not that hard. You go to a site called Office Ally and set up an account free of charge, then you create batches of 1500, and send them, not much to it, really. I went from, 1. give the client the form, to 2. bill electronically myself, to 3. hire a service, in the last 2 years. It's a bit of a learning curve, but, yes, it helps your practice, if you advertise that you bill and accept all insurances. Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - Angela Pfaffenberger, PH.D. Chinese Medicine Monday, March 30, 2009 5:44 PM Re: insurance form Regards, Angela Pfaffenberger, Ph.D. angelapfa www.InnerhealthSalem.com Phone: 503 364 3022 - Yuliya Goldberg Chinese Medicine Monday, March 30, 2009 5:18 PM insurance form Hi everyone, can someone send me a sample of the form that you use in your office that you give your patients so they can send that to their health insurance? I would really appreciate it. One of my patients asked me to give them a form like that and I have not done that before. Thanks Yuliya Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2009 Report Share Posted April 1, 2009 Please feel free to use this link and whiteout the name and address after printout. It works well and is free. http://www.lni.wa.gov/Forms/pdf/245127af.pdf Michael W. Bowser, LAc Chinese Medicine herbsnacupnxr Tue, 31 Mar 2009 16:39:11 +0000 Re: insurance form you're basically asking for a superbill, that you make listing the diagnosis & procedure codes, with fees. You need you tax-id/ss# (rec. #1 due to fraud), license #, & signature, with a space for the patient's name, address, insurance info, for them to fill in and send to the insurance. You'll need a reference for codes, however. It could be as simple as this: provider name, L.Ac. address Telephone: e-mail: FEE SLIP Patient Name, SS# Address Phone Insurance Co. Policy No. Group No. Date of Service Diagnosis Code Procedure code Fee Other ( ) Fee for herbs: $ ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬signed your name, L.Ac. Provider Tax ID No. Lic. No. _______________ Hotmail® is up to 70% faster. Now good news travels really fast. http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_70faster_032009 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2009 Report Share Posted April 1, 2009 Thank you very much for your help. Yuliya --- On Tue, 3/31/09, mike Bowser <naturaldoc1 wrote: > mike Bowser <naturaldoc1 > RE: Re: insurance form > Chinese Traditional Medicine > Tuesday, March 31, 2009, 7:44 PM > Please feel free to use this link and whiteout the name and > address after printout. It works well and is free. > http://www.lni.wa.gov/Forms/pdf/245127af.pdf > > Michael W. Bowser, LAc > Chinese Medicine > herbsnacupnxr > Tue, 31 Mar 2009 16:39:11 +0000 > Re: insurance form > > > > > > > > > > > > > > > you're basically asking for a superbill, > that you make listing the diagnosis & procedure codes, > with fees. You need you tax-id/ss# (rec. #1 due to fraud), > license #, & signature, with a space for the > patient's name, address, insurance info, for them to > fill in and send to the insurance. You'll need a > reference for codes, however. > > > > It could be as simple as this: > > > > provider name, L.Ac. > > address > > Telephone: e-mail: > > > > FEE SLIP > > Patient Name, SS# Address Phone > > Insurance Co. Policy No. Group No. > > Date of Service > > Diagnosis Code > > Procedure code Fee > > Other ( ) > > Fee for herbs: $ > > > > ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬signed > > your name, L.Ac. > > Provider Tax ID No. Lic. No. > > > > > > > > > > > > > > > > _______________ > Hotmail® is up to 70% faster. Now good news travels really > fast. > http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_70faster_032009 > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted April 1, 2009 Report Share Posted April 1, 2009 If you plan to understand insurance billing, you should take a seminar on it and get the coding books by AMA and/or AAC. Michael W. Bowser, LAc Chinese Medicine ygold77 Wed, 1 Apr 2009 08:55:25 -0700 RE: Re: insurance form Thank you very much for your help. Yuliya --- On Tue, 3/31/09, mike Bowser <naturaldoc1 wrote: > mike Bowser <naturaldoc1 > RE: Re: insurance form > Chinese Traditional Medicine > Tuesday, March 31, 2009, 7:44 PM > Please feel free to use this link and whiteout the name and > address after printout. It works well and is free. > http://www.lni.wa.gov/Forms/pdf/245127af.pdf > > Michael W. Bowser, LAc > Chinese Medicine > herbsnacupnxr > Tue, 31 Mar 2009 16:39:11 +0000 > Re: insurance form > > > > > > > > > > > > > > > > > > > > > > you're basically asking for a superbill, > that you make listing the diagnosis & procedure codes, > with fees. You need you tax-id/ss# (rec. #1 due to fraud), > license #, & signature, with a space for the > patient's name, address, insurance info, for them to > fill in and send to the insurance. You'll need a > reference for codes, however. > > > > It could be as simple as this: > > > > provider name, L.Ac. > > address > > Telephone: e-mail: > > > > FEE SLIP > > Patient Name, SS# Address Phone > > Insurance Co. Policy No. Group No. > > Date of Service > > Diagnosis Code > > Procedure code Fee > > Other ( ) > > Fee for herbs: $ > > > > ¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬signed > > your name, L.Ac. > > Provider Tax ID No. Lic. No. > > > > > > > > > > > > > > > > > > > > > > > ________ > Hotmail® is up to 70% faster. Now good news travels really > fast. > http://windowslive.com/online/hotmail?ocid=TXT_TAGLM_WL_HM_70faster_032009 > > Quote Link to comment Share on other sites More sharing options...
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