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The Medical Billing Process

We work with you to make the startup medical billing process as smooth and painless as possible. For most practices, it takes roughly 1 to 3 months from when you sign the contract with us until you “go live”.  Our startup team works with you every step of the way to ensure a smooth transition.

1

Overview

Billing Advantage 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.

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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.

2

Who enters the data?

There are several options for entering data. Some of our customers prefer us to do all of the data entry for them. Others prefer to enter the basic demographic information on patients, along with the CPT code, diagnosis code and other basic encounter information. This data can either be entered directly into Kareo, the Practice Management software we use, or into Practice Fusion, the free EHR software. Doing this part of the data entry may decrease your cost with us, and we provide free training in how to do it.

8

What about patient billing and patient phone calls?

Most of our customers want us to manage their patient bills for them.  We keep track of any amounts owed by your patients, including co-pays, deductibles, etc.  If you want us to, we mail out bills monthly to your patients, and take phone calls from them if they have questions about their bills.

3

How do we exchange patient data and other information?

We are flexible about how we exchange information with you. Options include electronic transmissions, US mail and fax. Some customers prefer to enter information directly into our web-based software system. We customize information exchange in each case to suit your practice needs.

9

How does Billing Advantage 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), and showing the amount owed to us.

4

How does claims follow-up work?

One of the main points of using a billing service is that we do all the follow-up on claims. You are relieved of the burden of worrying about which claims 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. We contact the insurance companies immediately on any denied claims, and 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.

10

What about reports?

We have a wide range of reports available, including aging reports, patient demographics, etc.  There is no charge for receiving these reports on a regular basis.  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.

5

What about secondary insurance?

We automatically bill any secondary insurances at no extra cost.  We use the same system to follow up on secondary claims as primary claims.

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Customer Support

We pride ourselves on offering outstanding customer service. Each practice is assign to a Billing Team. That way there is a group of trained billers who are all familiar with your practice, and can cover any issues that arise, even if one member of the team is out sick or on vacation. You will have a direct contact phone line and email address for the billing team, as well as a HIPAA-compliant electronic contact through BA Notes, our secure, online communications program. We strive to provide outstanding customer service, and to respond to all phone calls, emails, faxes, etc. very promptly. We believe that outstanding customer service and excellent communication are two of the most important aspects of a good billing service.

6

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.

12

Startup

We work with you to make sure that there is a smooth transition. The time from signing the contract to sending out the first claims varies with the size and complexity of your practice, but is roughly 2 to 3 months. 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.) The start-up medical billing process is described in more detail here.

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