Orion Medical Billing, LLC

03/28/2025

Big win today! Lifewise insurance changed their fee schedule in December, yet they have continued to pay some providers the old fee schedule rates, which will end up costing these providers money in the long run. After getting zero traction contacting the claims department multiple times, I followed Don Self's advice and contacted the CEO of Premera | Lifewise directly. Within 1 week, I've received 2 phone calls from Lifewise thanking me for letting them know, letting me know they are trying to find where the problem is and they are starting to reprocess claims, letting me know that this caused them to give extra training to their claims department in how to handle situations like this, and letting me know that they will update me again next week as they continue working through the problem. The last call I received, the person also made sure I had their direct line in case I have any questions. Thank you for the training and advice Don Self!

03/28/2024

We don't get to hear much about wins in our industry, so I wanted to share one that happened this morning.
Due to technical issues, a claim was originally submitted with a modifier that it shouldn't have had. The claim was denied, corrected and resubmitted with the correct codes. However, Regence's adjudication system wouldn't accept the claim and kept returning it to our clearinghouse saying it's a duplicate of a previously processed claim line. We've been fighting this since October. I finally got them to escalate this case to their internal investigations team and within less than 24 hours they got back to me with a solution that they are going to request a change to the claim with a verbal dictation of what needed to be fixed, so we don't have to keep waiting for them to figure out why the system keeps denying the claim. So grateful for the people at insurance companies that are able to be problem solvers instead of not being helpful.

02/05/2024

01/30/2024

Come visit us this Thursday and Friday, February 1st and 2nd

01/03/2024

Regence Massage Billing Reminder: state licensing dictates which services a provider may practice. Massage therapists are eligible to bill CPT 97110, 97112, 97124 and 97140. In Oregon, they may also bill CPT 97026, in accordance with Oregon state law.

01/03/2024

New Appointment Wait Times Standards are now in effect for Aetna. These standards affect primary care physicians (PCPs) and behavioral health (BH) providers. For detailed information please check out page 32 or 53 of the December issues of the Aetna monthly OfficeLink Updates or contact us directly.

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12/12/2023

Do you get those pesky paper credit cards or checks through Echo Health from insurance companies? You are now able to set-up EFT though Echo Health! There are two options: a Single Payor option and an All Payor option. The All Payor option does include a transaction fee, but if you do the Single Payor option and register for each payor that you get payments from individually, there is no fee for the EFT.

08/31/2023

Aetna - telemedicine coverage is ending for certain services effective December 1, 2023. Check the link below to see if the CPT codes you use will be affected.

05/25/2023

Per the June quarterly newsletter from Aetna - Telehealth coverage will remain in effect after the Public Health Emergency (PHE) expiration date of May 11. An updated telemedicine policy will be shared in Q4 2023. View the updated COVID-19 FAQs (PDF) to get the latest telemedicine updates -

05/16/2023

🔥FUN FACT FRIDAY🔥
📣NO SURPRISES ACT📣

What types of providers do the No Surprises requirements apply to?

When assessing whether a No Surprises requirement applies to a particular provider, it is important to look at how the provider practices, rather than the provider’s specialty type, license, or certification. The rules apply broadly to any physician or other health care provider who is acting within the scope of practice of that provider’s license or certification under applicable state law. However, some providers may not practice in a setting or manner that triggers certain requirements. For example, a provider who never furnishes services in connection with a visit to a health care facility or emergency facility wouldn’t furnish items or services that fall within the balance billing protections. However, that same provider would, for example, need to provide a good faith estimate of expected charges to uninsured or self-pay individuals, when applicable, and comply with the continuity of care and provider directory requirements.

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Including the "No Surprises Act" in 2023 on Billing Companies and Physicians Practices" From 5/9/2023.

For reference... https://zurl.co/uiiF