Why should I outsource my medical billing?
Your billing will be done by a professional that knows the industry and has the tools and experience to get the job done. You will not have to worry about your billing getting done if your biller calls in sick or is on vacation. You will be able to eliminate or reduce cost associated with Workman Compensation insurance, salary, etc. Your cash flow will increase and certain office related cost will be eliminated or drastically reduced.
If you had been diagnosed with digestion issues, you would go to a gastroenterologist. They are specialists. Outsourced billers are specialists as well.
The industry average shows that 40 percent of claims are returned, underpaid or denied due to errors or missing information. Most of those claims are never resubmitted, therefore resulting in lost revenue. Our goal is change this percentage for your practice.
How will you improve my cash flow?
We are compensated based on what is collected, therefore our only focus is medical billing. We strive to work very hard to maximize your collections. We are the experts and have all the correct tools to get the job done correctly the first time. We build strong relationships with our clients and take care of any problems that may arise directly and without any hesitation. You will see immediate results in your cash flow.
Are claims submitted electronically and how are insurance claims and payments handled?
Most claims will go out electronically, while some carriers This is the case for primary and secondary claims. Most claims are adjusted within 7 to 10 days. Medicare Explanation of Benefits (EOBs) are received electronically and automatically post in our system. Secondary carriers or patients are billed automatically. It is important to remember that most insurances will require credentialing with them in order for us to submit your electronic claims on your behalf.
What investment is necessary to implement your service?
You will not need to invest anything for our services.
How do we get our claims to you and how often should we send?
Charges/claims are sent to our office daily via fax or scanned/emailed.
Should I collect co-pays?
YES. The patient has a contract with their insurance carrier and failure to collect could possibly be in violation of this contract. If a copay is not collected at time of service, the patient will receive a statement.
What is your collection rate?
We will collect 100% of the allowed amount per the contract with the insurance carrier. Any unpaid claims over 60 days are followed up monthly and appeals are filed as necessary. The collection process does not stop until our clients are paid 100% for the services they provided.
Are patients’ statements professionally formatted?
Our patient statements are sent out electronically via BillFlash. Clients have the option to allow credit card payments to be printed on statement.
What type of reports are available?
We have a variety of reports that we make available to you. Our clients typically chose what reports they need and how often they need them. A majority of clients chose to receive their repots monthly, after month end has been closed.
Is my patient and billing data secured?
Yes!! Our data is backed up several times during the day, as well as nightly. In addition, all servers are protected by firewall hardware, virus and malicious programs software. Our team signs a confidentiality agreement and we do not give out any information over the phone to anyone but the patient and/or responsible parties.
What do I have to do to sign up for your service?
Once we have an agreement, we will send you three documents. These are a Billing Services Agreement which outlines the terms as well as each of our responsibilities. The next is a business Associate Agreement. This is a HIPAA document covering HIPAA requirements. Lastly, we have a Practice Information Sheet. This contains your information such as tax ID, state license, Medicare provider number, etc.
How quickly do we get reimbursed?
The average turnaround from start to finish of the claims process is typically 30-45 days. There are cases where we get paid sooner than that and some cases, it may take longer. CMMS/HCFA is required to hold all claims for 13 days for electronic submissions and 23 days for paper submissions. The National average of a claim in AR is usually 43 days.
How quickly can you be up and running?
Usually takes 1-3 days for the transition process. If you are a new practice, this may take a little longer due to credentialing.
How do we get our existing patient data to you?
We will log in to your system and get the information. Any new patients will be scanned in and faxed/emailed to us.
Should we continue to work our previous billings/collections once you take over?
No, once the transition process is complete, we will handle any and all old and current billing and claims.
What is your turnover rate and dedication of your staff?
We are proud to say that a majority of our billing staff has been with us for 5+ years and bring many years of experience to the table. Our billing is a “team effort”, therefore the collections process is not affected by vacation or illness. Our team consists of four billers that are all cross-trained on your account.
How often are my claims processed?
We will send out all claims within 24 hours of receiving your charges. If claims require any additional information, we will contact you for the information and claims will be sent out accordingly.
Where does my money go?
All payments are sent directly to your office.
How much experience do you have with my medical specialty?
90% of billing is billing, regardless of specialty. The 10% differences tend to be discipline specific. We have an experienced staff that has billed everything from Family Medicine and Internal Medicine, to Podiatry, Dermatology, Mental Health, Chiropractic, and Cardiology.
I’m new in my practice – How do I set my fees and will you assist in watching reimbursements?
We will monitor your reimbursement rates and will make sure that you are receiving payments with correct fees and maximum allowed. Typically, fee schedules are set/re-set using the Medicare allowed fee structure multiplied by 130% or 1.3. We will provide any information to you to make sure you are maximizing your reimbursements.
Why do some billing firms only charge by the claim vs. a percentage of collected revenue?
A billing company will be more compelled to follow through and work earnestly on your claims, denials, secondary submissions and maximum reimbursements if a client charges a percentage of revenue collected. A flat-fee per claim is typically charged by newer billing companies that are only skilled in the initial transmission of a claim to the insurance company.
What is an acceptable AR (Accounts Receivable) amount?
Over the years, we have found that a good formula for determining an acceptable AR is to multiply your gross average monthly charges by 2.5 to 3. For example, if your average monthly charges are $40,000. Then multiply that by 2.5, which would be $100,000. If you are above this number, there is a good chance that you will need to take a longer look at your AR.