A billing service that does not bill the sessions accurately, misses Timelines, or does not do enough follow-up can have a disastrous effect on your business; however, a well run billing service can ease your life and greatly improve both your cash inflow and total income.
However, this is also being promoted from home as some people have started calling themselves as medical billers with little or no experience of the field, and this has spoiled the whole scenario. A typical claim has a lot of details which should be accurate and precise.
A competent billing service drives positivity in your practice and in your life. This positivity enhances your patient seeing hours or some better creativity hours that are lost behind submitting bills and waiting for refunds. Billing company doesn’t leave a single penny uncollected to provide unprecedented boost and control in your cash flow.
MDofficeManager provides the best combination of services to make physician work flawless. Our highly experienced and professional staff handles end-to- end billing needs with ease, leaving a feeling of peace and relaxation on your hand. For billing to be handled professionally, accurately, and thoroughly, MDofficeManager will be your right choice.
A physician providing care for the patient and managing revenue simultaneously is not an easy proposition. Certain aspects become hard to manage like scheduling appointments, following unpaid claims, etc. At MDofficeManager, we also vacate you from keeping up with all the regulations and procedures in ever-changing industry standards.
MDofficeManager is a professionally managed company by physicians and serving multi-specialties across the country.
Don’t be offended to ask questions while choosing a billing service. It is an important decision that can determine the financial health of your practice. Outsourcing your insurance and patient billing to professional medical billers like MDofficeManager frees up you and your office staff from the burden of medical billing and allows them to devote more time to patient needs along with the natural approach. Your office environment will be more relaxed and your cash flow will increase. It will be a win:win situation.
ESSENTIALS OF A BILLING SERVICE
How can one find the difference between a fly-by-night medical billing company and a billing company to which they can hand over their patient’s medical information with confidence? If they know the criteria by which to judge a medical billing service, they’ll be able to select a company that will significantly decrease their time spent on billing issues and increase their time spent on patient care.
To correctly choose a billing company, a provider will need to evaluate these criteria:
Criteria 1: Level of Service
The following are considered while considering a service provider:
- Pursuing denied claims.
- Billing follow-up.
- Complying with regulations.
- Reporting and analysis. What reports would be provided? Frequency of reports? Reports on demand?
Criteria 2: Industry Experience
Did you consider experience, specialty expertise, billing certification or knowledge about Medicare and Medicaid is necessary while considering a medical billing & coding provider? This includes:
- ICD-9, CPT-4 & HCPCS Coding.
- Medical Terminology.
- HIPAA and Office of Inspector General (OIG) Compliance.
- Insurance claims and billing, appeals and denials, fraud and abuse.
- Information and web technology.
Criteria 3: Use of Technology
Considering to have a proper procedure in place along with a billing software is of an added advantage is one of the criteria. One would want to know a company’s information sharing, data security, recovery procedures, and data backup procedures.
Here are some potential technological issues in those realms that will need to be addressed:
- How will super-bills and claims be shared?
- How does billing service fit with the provider’s EHR strategy?
- Does the service have an integrated EHR?
- What about data security?
- What are the procedures for disaster recovery?
- Where and how is the storage of backup data?
- Will a provider need to install and maintain software or would they be accessed online?
- What about compliance of HIPAA?
By choosing a medical billing service that integrates with a provider’s EHR (or provides their own EHR) this gap can be closed even more.
Criteria 4: Pricing Options
Huge volume of dollars are moved from one account to another so pricing is important, it’s a social responsibility.
- Percentage-based: The service will charge a percentage of collections or they will charge a percentage of gross claims submitted or total collections.
- Fee-based: With this model, the billing services charges a fixed dollar rate per claim submitted.
- Hybrid: With this model, the billing service charges on a percentage basis for certain carriers or balances and charges a flat fee for others.
There are many types of charges other than above like startup fees, annual fees, backlog charges, etc. which need to be clarified at the start.
Percentage-based models are most common on the market today, fee-based models are also used widely as an option, with the hybrid option appearing with less frequency. Many billing companies offer a combination of two or three of these options.
FUNCTIONS OF A BILLING SERVICE
The Entire Revenue Cycle – Automated & Interoperable
- Contract Management.
- Fee Schedule.
- Check In & Check Out.
- Charge Entry.
- Track Claims.
- Reject Management.
- Pre-Remittance Claim Status.
- Post & Apply Payments.
- Electronic EOB/ERA.
- Account Follow-Up.
- Patient Billing.
- Denial Management.
- Reporting & Benchmarking.
HOW MDofficeManager CAN HELP?
Our billing services have the capability to submit claims electronically, which has become the norm for claims submission. Online claim management means on demand access to your detail just a click away that is quick, easily manageable, secure compared to paper.
However, keep in mind, that some of the smaller insurances and HMOs do not accept electronic submissions at this time, so some claims will still be submitted on paper.
MDofficeManager offers several different options for you to submit demographic and claims information to us. Most of our customers prefer to enter their data directly into our web-based MDofficeManager PM system. Providers will dictate or use our EHR system to complete patient note. Our AAPC certified coders will review the documentation and complete coding. If it is required, they will educate providers for better documentation to comply with regulations. We then extract the information needed to submit the claim without you having to do anything further. We also offer other option for customers who do not want to do any data entry themselves.
We follow up on all claims to be sure that they are received in a timely manner and paid. Since the vast majority of claims are submitted electronically, we have immediate confirmation of claims receipt, and if there are any issues with a claim, we know about it quickly. We follow up immediately on any claims that are rejected, denied, or underpaid, or on any claims where there has been no response from the insurance company. You don’t have to worry about claims follow up, tracking specific claims, etc.
MDofficeManager works with your practice to design a system where your office will get us the information we need to do your billing in the fastest, most accurate way possible. We bill out your claims and follow up to make sure they get paid.
We work with you to make sure that there is a smooth transition. From the time of signing the contract to sending out the first claims varies with the size and complexity of your practice, but is roughly two to four weeks. In all cases, we ensure that all the necessary setup is completed and verified before any claims are sent out. We provide training as needed throughout the startup process. (On-site training is available at an additional fee.)
Some practices would like us to do complete benefit verification prior to the first visit. When you receive a phone intake from a new patient, you fax this to us, including the demographic and insurance information. Within 4 business hours, we will obtain the following information and fax it back to you:
- Is this a valid policy?
- Is any authorization required?
- Is the clinician you intend to assign the case to in or out of network?
- What is the co-pay?
- Is there a deductible?
- What is the correct claim mailing address for paper claims, and do they accept electronic submissions?
We automatically bill any secondary insurance at no extra cost. We provide the same thorough level of follow-up for secondary claims as we do for the primary claims.
We send out monthly statements for any amounts owed by patients for co-pays, deductibles, etc. If a patient has a question about a bill, they can call our office and our professional staff will review all aspects of the invoice with them and answer all of their questions. This relieves a huge burden from your office staff, as they no longer have to answer patients’ questions about their bills.
We offer free customer support. Our courteous, professional staff is easily reachable by e-mail, IM and phone, and is happy to answer any questions. If you need we provide support through our web portal.
There is an incentive up to $44,000 per provider available to physicians & certain other medical providers who convert to an Electronic Health Record System. This money is available over five years for practices that begin using a qualified EHR System by 2011.
SOME IMPORTANT CONCERNS
How do we exchange patient data and other information?
MDofficeManager is flexible about how we exchange information with our clients. Options include secure electronic transmissions, fax, and US mail. Some clients prefer to enter information directly into our web-based MDofficeManager PM system. We customize information exchange in each case to suit your practice needs.
How does claims follow-up work?
We at MDofficeManager follow up on all claims. You are relieved of that burden of worrying about which claims are paid, how to resolve denied claims, and checking claims that were submitted but never paid, etc. We have a very thorough system which ensures all claims are received in a timely manner by insurances. And we take the pains to contact the insurance companies immediately on any denied claims, we follow up on any claim that has been submitted but has not been adjudicated. We also review claims that paid at a rate that is lower than we expected.
Who receives the checks?
Most of our customers prefer to have the checks sent directly to their office. Some of our customers prefer to have us manage their deposits for them. We can discuss which of these options best meets your needs. Increasingly payments are made by direct electronic funds transfer, directly from the insurance companies into your bank account.
How do payments get posted?
For many insurance companies, we receive an electronic remittance advice which shows the payments received, and we can import this directly into our system. For those that still use paper, when you receive a payment from the insurance company, you send us a copy of the EOB which accompanies the check. We post the payment based on this information. Whether the claim is paid electronically or by a paper check, as soon as the payments are posted, we immediately follow up on any denials, unpaid claims or claims paid at too low a rate. For patient payments, you send us a list or report of any patient payments you have received so we can post these into our system.
How does MDofficeManager get paid?
We charge a percentage of the amount you receive on each claim. We do not get paid until you do, and our payments are based only on the amounts you receive, not the amounts billed. We send you an invoice each month listing all the payments received (both insurance and patient payments), showing the amount owed to us.
What about reports?
We have a wide range of reports available, including aging, payment, patient demographics, etc. You can run your reports anytime from our PM system or contact our office. In addition, all of our software is web-based, so you can log in at any time to see more detailed information or print out your own reports. You also have the ability to design your own custom reports quickly and easily that will download directly into an Excel spreadsheet.
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