Crash Course for Billing & Reimbursement for Lactation Practice by Annie Frisbie

Crash Course for Billing & Reimbursement for Lactation Practice

Everything you ever thought you would need to know about insurance billing and reimbursement for lactation services. Whether you are out-of-network or in-network, you’ll learn what you need to know to maximize what your clients get reimbursed and what you can get paid for lactation services.

A comprehensive guide to in-network and out-of-network insurance for lactation practice

In this book and the accompany resources, you’ll develop an understanding of the billing process from start to finish so that you can create the billing policies and procedures that make the most sense for the way you want your practice to work. You’ll learn all about billing, coding, and documentation, both in-network and out-of-network.

Basically, we’re all tearing our hair out trying to figure out how to get ourselves paid and our clients reimbursed. Any frustration you are feeling has been felt throughout our community. However, the fight for reimbursement is absolutely worth fighting. We may not win, but the law is on our side and we can harness the tools available for good and get our services covered. 

Topics covered include:
  • Understanding insurance codes and applying them to your specific situation
  • In-network billing
  • Out of network billing
  • Superbill templates suitable for use in any paperless or paper workflow
  • Creating and submitting claims
  • The in-network application process
  • Working with a biller
  • "Incident to" billing
  • Avoiding insurance fraud
  • Detailed, granular billing workflows for popular EHR charting platforms, including IntakeQ, Practice Better, ChARM, Jane and Mobile Lactation Consultant
  • Controversies in lactation insurance billing—where you’ll get all sides of the story

Testimonials

Thank you so much for all of your amazing resources! I also just purchased the new Crash Course in Billing and it has already been so helpful in clarifying many things that have been making me crazy lately. Can’t thank you enough, I feel like your resources are exactly what I’ve needed and I’m so glad they’re available. : ) 

Chelsea DeSorbo IBCLC
This book is essential reading on how to navigate the murky waters of insurance billing and coding, both as an in-network provider and for understanding responsibilities associated with out of network billing. It’s well written, easy to understand, and for something written on my least favorite subject, surprisingly enjoyable to read!
Rachel King IBCLC
I read through the book and I have to say it is great. It is comprehensive without being overwhelming and has a wonderful flair of fandom and geeky-ness. Everything you have here is what I’d tell people, only you have put it far more eloquently. 
Michael Morgan, IBCLC Billing Services

What's included?

File Icon 17 files Text Icon 95 text files

Contents

Welcome!
Usage Permissions and Copyright
How to use the Crash Course by Donna Sinnott, IBCLC and Annie Frisbie MA, IBCLC
Foreword by Donna Sinnott, IBCLC
Preface to the 3rd Edition by Annie Frisbie MA, IBCLC
Introduction
About the Authors
Have questions?
Understanding Lactation Services and US Law
The Affordable Care Act
Lactation Consultants and the ACA
In-Network vs. Out-of-Network
Gap Exceptions or Single Case Agreements
The NPI—Every Provider Needs One
HIPAA
Insurance Fraud
Dept of Labor ACA FAQ.pdf
102 KB
NWLC Toolkit.pdf
234 KB
Applying to be in-network
About applying to be in-network
Step One: Is Going In-Network Right for Me?
Step Two: Submit an Application to a Payer
Step Three: Create Your CAQH Profile
Understanding Your Contract
Coding
Overview
Allied Health
The Complexity of the Dyad
Coding Overview
Place of Service Codes
Diagnosis codes
CPT (Procedure Codes)
Education CPT Codes
Preventive CPT Codes
Evaluation and Management CPT Codes: Introduction
E&M Codes: Chief Complaint
E&M Codes: History of Present Illness
E&M Codes: Examination
E&M Codes: Medical Decision Making
E&M Codes: Counseling & Coordination of Care
E&M Codes: Office Vs. Home Visit explained
E&M New Patient Office/Outpatient Code List
E&M Codes: New Patient, Home Code List
E&M Codes: Established Patient, Office Code List
E&M Codes: Established Patient, Home Code List
E&M Codes: Time
E&M Codes: Health and Behavior Assessment
Telehealth codes
Modifiers
Insurance Coverage And Tele-Lactation
Aetna allowed codes for in-person lactation
Aetna allowed codes for tele-lactation
Documentation
Charting to Justify Your Coding
Creating Your Charts
Education Code Documentation
Preventive Code Documentation
Health and Behavior Assessment Documentation
Evaluation and Management Code Documentation Introduction
E&M Documentation: Chief Complaint & History of Present Illness
E&M Documentation: Review of Systems
E&M Documentation: Pertinent Past, Family and/or Social History
E&M Documentation: Examination
E&M Documentation: Medical Decision Making
E&M Documentation: Time
E&M Code Chart- Office Visits.pdf
31.7 KB
E&M Code Chart - Home Visits.pdf
32.2 KB
Donna's printable charting forms for E&M documentation
80.5 KB
1997 guidelines for documentation of E&M services.pdf
595 KB
DHS CMS Evaluation and Management Services.pdf
3.09 MB
Creating Your Fee Structure
Your Out-of-Network Fees
Sample Out of Network Fee Chart.pdf
27.2 KB
Your In-Network Fees
Sample In-Network Fee Chart.pdf
24.4 KB
Fee Calculator spreadsheet
11.3 KB
Understanding Cost Sharing
Getting Paid
Payment Processing
Additional Fees
Out of Network Superbills
Superbill Template (Printable)
23.4 KB
Out of Network Claims
Sample CMS1500.pdf
3.61 MB
In-Network Claims Introduction
Creating and Submitting Claims
Billing for Baby
Estimation of Benefits (EOB)
Sample EOBs.pdf
436 KB
Insurance Payments
Appeals
Sample Letter of Medical Necessity.pdf
27.5 KB
Corrected Claims
Payment Policies
In-Network Payment Policies (attorney-reviewed)
27.5 KB
Waiver for Non Covered Services
Contracting with Physicians and other Outpatient Providers
What is Incident To Billing?
Explaining the Affordable Care Act to a physician or other health care provider
Service Descriptions
Scenarios and coding
Coordination of Care with OBGYNs & PAs, CNMs, NPs under OB
Coordination of Care with Pediatricians or Family Practice Physicians & PAs, CNMs, NPs under Pediatrician or Family Practice Physician
Coordination of Care with PAs, CNMs, NPs
Separate Entity
Outpatient Facility (Clinic, Freestanding Birth Center, etc.)
Medicaid billing
Other income sources to explore
Recommended Resources
Crash Course Tech Handbook
Tech Handbook Intro
G Suite
ChARM
Mobile Lactation Consultant
IntakeQ
Practice Better
Jane
Availity Tutorial
Additional Resources
Words of Wisdom from Lactation Consultants
Making Sense Of Insurance Coverage For Lactation Care (Podcast)
Bibliography

About Annie Frisbie

Annie Frisbie has served hundreds of families since becoming an IBCLC in 2011. Her mission is to empower IBCLCs to transform their private practice to increase productivity, reduce stress, improve client communications, and cultivate career longevity through her deeply researched yet accessible books, tools, and services.
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