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.
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.
Who enters the data?
There are several options for entering data. The software we use is called Kareo. If you choose to use Kareo’s EHR or one of Kareo’s partner EHRs, the data is imported directly into the system. You can also enter the data directly into Kareo. Alternatively, if you are able to get us the data on an Excel spreadsheet, we can upload it directly. If none of these are a good option for you, you can send us the data on paper, and we will enter it manually.
How do we exchange patient data and other information?
We are flexible about how we exchange information with you, and we have several HIPAA compliant options. These include electronic transmissions, U.S. mail, and fax. Documents can also be uploaded directly into Kareo. In addition, we use a secure, HIPAA compliant email system. We customize information exchange in each case to suit your practice needs.
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 that 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 expected.
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.
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 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 Explanation of Benefits that accompanies the check (EOB). 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 that are received at the time of the visit, these are generally entered as part of the encounter data sent to us. For payments received at a later date, you send us a list or report so we can post these into our system.
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. We are also able to send out electronic statements by text or email. These methods of billing have a much higher collection rate.
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.
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.
We pride ourselves on offering outstanding customer service. There will always be one primary contact person assigned to your practice, as well as a group of well-trained billers who are all familiar with your practice and can cover any issues that arise, even if your primary contact person is out sick or on vacation. You will have a direct contact phone line and email address for your contact person, as well as a HIPAA-compliant electronic contact secure, online email 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.
We work with you to make sure that there is a smooth transition. We are there with you every step of way. The time from signing the contract to sending out the first claims varies with the size and complexity of your practice, but is roughly 1 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 process is described in more detail here.