Our Most Frequently Asked Questions
If you have questions that are not answered here, please do not hesitate to e-mail or call us and we'll be happy to address any issues or concerns that you have.
How do I get information to you?
We offer various transmission methods based on the needs of the clients. Local clients are welcome to come by our office; or we will send a courier to pick up your work. Clients outside of our metropolitan area may use our secure FTP site, fax service or Federal Express (at our cost.).
Are all claims filed electronically?
No. Over 90% of the claims will be processed electronically, but there are some exceptions. For surgeons, a single operative session that includes more than three unrelated procedures should be submitted on paper with documentation. Most worker's compensation claims also usually require copies of the office notes or operative report. Although these claims could be filed electronically, since the third party payer will routinely request the paperwork on claims such as those mentioned, By filing on paper with required documentation, a client receives payment quicker.
What clearinghouse do you use to file electronically?
At this time the majority of our claims are filed direct with the third-party payers. We use Capario to file some smaller commercial payers.
How often do I receive my payments?
Your payments go directly to you as soon as they are made! Whenever possible, we arrange for deposits to be electronically transmitted to your bank account. For paper payments, our preferred method is to establish a "lockbox" with your bank. Payments would be mailed directly to a P. O. Box associated with your account. EOBs and copies of checks would then be forwarded to us for posting to patient accounts.
How quickly will I receive payments?
Although insurance payers vary, a good rule of thumb is that you will receive approximately 80% of what is collectible within 45 days of billing. Medicare pays within 13 to 21 days of electronic transmissions. Electronic payments usually will be in your bank account two business days after Medicare transmits the payments. Most Medicaid carriers follow the same payment cycle although Medicaid in states with waiver (such as Tennessee) normally wait at least thirty days before paying.
Do you file secondary and tertiary insurance?
Yes. Whenever possible we make use of electronic crossovers in filing secondary insurance. If secondary's are not paid within fifteen days of receipt of the primary EOB, we will file secondary insurance on paper with a copy of the primary EOB.
Do you bill patients for patient balance?
Yes. We also provide patients with written explanations of why an insurance company did not pay on its bill (unless the denial is related to something that needs to be corrected by your office or our office.) However, we are NOT a collection company. We will bill a patient three times after the balance is owed by the patient. If the patient returns for additional visits, any past balance will be included on current statements.
How do I know if there is a problem with a claim?
Two way communication is key to the success of any billing operation. Our clients choose whether they wish to be contacted by fax or e-mail.
We also communicate with you concerning a claim if it is flagged in any of our prepayment reviews (such as lack of medical necessity based on diagnosis provided). We will also query about demographics if our records show that information on file is incorrect.
Post filing communications:
Most commercial carriers provide almost immediate feedback for insurance problems. We will provide information about these rejections as soon as we become aware of them.
In addition, you may review the status of any account via your secured link into our system or on your monthly printout of active accounts.
Whenever we receive a denial on a claim that is not related to diagnosis and coding, (such as a deductible or a lapse in coverage) we will contact your patient about the denial.
How long does it take to implement your services?
The short answer: usually about a month.
More than you want to know: For new practices or practices that have never been set up to bill electronically, it takes approximately three months to obtain provider number and billing numbers. Most, but not all third party payers, will pay for claims retroactively to the date of application.
During the implementation phase, we will become familiar with your practice, review your fee schedule and set up forms such as super bills and patient information forms.
How much do your services cost?
Our services are customized to meet your needs and based on a percentage of your collections. The fee is dependent on your patient mix, average allowed charge per bill, the volume of your practice and which services you require us to perform for you. For example, a surgical client who does his own follow-up will be charged less than a pediatric practice where we handle all the follow-up. Please refer to our Services page for further information ... or feel free to contact us and request a no-obligation quote tailored to your exact specifications.