Medical Billing FAQs: 50 Frequently Asked Questions Medical Billing

Top Medical Billing FAQs

Billing medical claims is a complicated and nuanced process, even for those skilled in medical billing and coding. The choices are boundless, so it’s arduous and time-consuming to browse through endless web papers (and books) on the best medical billing apps. We have combined the most important details you need to know about medical billing services and how you can get the best out of them.

What Exactly Do Medical Billers Do?

A medical biller converts healthcare facilities into medical claimsand afterward sends them to insurance companies andpayers like Medicare and Medicaid. Medical billers must then follow up on theclaims to ensure providers obtain payment appropriately. Billing and coding are professions linked to these activities.

Medical coding includes knowledge of the method used to assign numerical codes to visits to physicians, hospital stays, and other procedures in health care.The basic tasks and the amount of time spent on each service would vary depending on the company. Generally,the services we provide at EMPClaims include:

Establishing patient payment arrangements and billing accounts for the job
Obtainingreferences and pre-authorizations as the procedures allow
Confirming eligibility and compensation for medications, hospitalizations, and procedures
Checking plans for patient follow up policies
Updating cash spreadsheets and running collection reports
Checking medical bills for consistency and completeness whileproviding any details that are lacking
Preparation, analysis, and forwarding of claims using billing tools, including the processing of electronic and paper claims
Following up on outstanding claims within the normal period of the billing process
Checking for consistency and compliance with contract discount on all insurance payments
If required, calling insurance firms in case of any difference in payments
Inquiry and appeal into all claims denials
Answering all patient or telephone insurance questions relating to specific accounts

In addition to the above, we also allow employers to request certain services theymight need that suit our skills and background experience or provide training for their staff.

What are 3 Different Types of Billing Systems in Healthcare?

Medical billing is a major part of the overall healthcare network. The network encompasses everything from medical insurance to patient care best practices, hospital facilities, and private practices. Health billing systems are multifaceted and can be split into 3 of the basic systems types.

Closed

A closed billing type is a system without allowance for transfers. This means that this program focuses on one single procedure in terms of medical payment systems. The best example of a closed billing system in your practice is to use EMRs or electronic medical records. The digital variants of old-school paper maps are simply EMRs. While paper is still used in modern practice today, it’s combined with other record forms. EMRs, as the system would mean, are closed. They will not require cooperation with other physicians and healthcare facilities such as labs or urgent care.

Open

An open system facilitates transfers between health care practitioners, services, facilities, and so on. EHRs, or electronic health records, are also an example of using an open medical billing system. Often, people in the medical field interchange EMR and EHR, but in fact, EHR-keeping is a highly collaborative record-keeping style that allows everyone involved to be privy to the patient’s healthcare.

Using an open framework means that medical billing programs such as AllMeds, ADVANCEDMD, GE Centricity, McKesson, and others have to be able to communicate easily and work together.Not all software allows an open system because they prefer to keep it closed and remainthe only ones with access to records of their patients. Some practitioners and healthcare facilities also claim that being extra cautious with open systems is necessary to protect patients’ privacy because of HIPPA.

Isolated

An isolated system is one that is segregated entirely from health care services, physicians, and procedures. Personal Health Records (PHR) are used in individual medical billing schemes. Patients retain all of their healthcare records so that they can plan and handle it themselves. Such reports are different and do not replace EMRs or EHRs; they primarily help the patient monitor their health details.

Because PHRs cannot legally replace official health records, it’s not usual to use isolated medical billing systems. Often, if the patient uses appropriate software, their PHR can be used to fill out official reports of the medical practices.Again, this includes open communication between the software to ensure everything is transmitted properly.

In terms of medical billing systems, each one has its pros and cons. Although records aren’t the only component of medical billing systems, they play a significant role in deciding the type of system you want in your practice. After deciding the program and record-keeping style you want, you can step forward by selecting a new software or retaining the one you currently have.

How Do You Get into Medical Billing?

We have spent years perfecting our service and process so we can deliver world-class service at all times. Our services include:

Patient Enrolment

Input patients into the billing services management scheme. After searching for any missing information, we collect all the demographic information correctly for medical billing.

Insurance Verification

For any practice or medical billing company, the key to success is to ensure the services theyhave provided are paid for. Our medical review team of experts will confirm eligibility for the claim and keep you aware of your patient visits.

Authorizations

We understand the value of insurance authorizations for services and operations as a committed medical billing company. We get the approvals done in advance and make sure that you get paid.

Medical Coding

Our certified coders know all specialties in medical coding. We are well versed in hospital/patient identification, emergency room e-code assessment, DRG / ICD-10-CM, CPT / ICD, HEDIS, and audits.

Medical Billing

Being one of the largest US medical billing firms, our mission has always been to provide the industry with a reliable service. We manage Medicare and Medicaid requests, Workers Compensation, No-Fault / Personal Injury, and other big company insurance plans.

Payment Posting

Our efficient medical billing organization is well versed in identifying and publishing insurance and patient payments. Our team is trained in making payment posts and ensuring that every line item is checked, certified, and posted to avoid loss of revenue.

Account Receivables Management

It’s necessary to appoint a dedicated team to handle A/R. The staff should be experienced in many specialties including insurance. Their duties are to administer A/R and negotiate claims while answering insurance and consumer queries.

Reporting

When working with a medical billing business, monitoring is essential to transparency for every customer. EMPClaims offers information that is easy to access, and that can be tailored to your needs. We assign RCM managers to your account and have regular meetings vital for a healthy relationship to continue.

Who is Eligible for Medical Coding?

Depending on the medical plan,the stateusually decides on eligibility. Data regarding eligibility are collected and handled by the State or its Fiscal Agent. In certain managed care waiver plans, an Enrollment Broker reviews the eligibility records, helping the patient pick a managed care plan to be enrolled in.

What Software Do You Use?

At EMPClaims, we have the proprietary software we use to handle all your billing processes from beginning to end. You don’t need any additional software for submitting your electronic claims to us. With a simple push of a button, we’ll receive all your claims. We’ll help with installing and setting it up on your network. It doesn’t matter if you use a peer-to-peer style network or client-server type network.

How Does Data Move from My Practice to Empclaims Billing?

There are different ways for you to transfer your data from your practice to our billing system. Customers can forward their documents to us through a secure VPN (virtual private network) link, remote desktop, etc. We have the versatility to work with you to create a charging capture system that matches your needs.

One of the most efficient ways is through a high-speed duplex scanner which we can assist your organization in obtaining and installing. This scanner can help to efficiently scan all of your documents.After the data reaches our server, we get to processing it. We begin the claim filing and processing ASAP to get your funds released on time.

How Quickly Do You File Claims?

We file your claims as soon as it has been reviewed by our auditors and does not contain any errors. Our team sends claims electronically as it’s the fastest and most efficient way to get results. We assure a 24 hours turnaround time from when we receive the data. Our billers can still use manual claimssubmission, but there are major limitations to this method. Manual claims have a high error rate, poor productivity, and a long wait-time to get payment from providers. Billing electronically saves time, energy, and resources, while minimizing human or administrative errors in the billing process.

How Do You Request Information from My Practice?

All of our clients have an email address they can use for a secure web log-in to our service. Through this medium, we can communicate with our clients and get responses when need be.

How are Claims Submitted?

We submit all of our claims through the most efficient process – electronically, for quick processing and dispersal of funds. For companies that cannot receive claims electronically, we proceed to use HCFA forms to process their claims and submit them.

Where Do the Payments Go?

All your payments and funds remain in your control. Customers must provide timely written notification of all collections they receive, including, but not limited to, patient cash payments, patient checks, payer checks, and EFT (Electronic Fund Transfer) deposits to EMPClaims. Our advice is to create as many payers as possible with the EFT (Electronic Fund Transfer) payments. The EFT payments will go directly into the client’s bank account, and our billing program will receive the corresponding ERA (Electronic Remittance Advice) through the clearinghouse.

Checks will come in the mail to the client for deposits from payers who don’t use EFT payments. If there is no corresponding ERA, the checks and the correct EOBs will need to be reviewed and given to EMPClaims. We want to make as many claims electronically as possible, and we set up as many payers as possible to collect the payments through EFT.

Do You Use Claims Editing Software?

Without software, it’s easy to do edits in real-time at any stage in your claim workflow. After that, we can automatically route claims for review to the appropriate agency. We also improve your claim editing process by applying both standard industry edits and our growing set of advanced and clinically sound editing rules, coupled with extensive flexibility in regulatory customization.

How Do I Know You won't Miss a Claim?

If you use free scheduling software, we will synchronize our accounting systems to ensure that all payments are properly paid.

How Will You Work My Accounts Receivable?

A successful insurance model helps health care organizations recover outstanding payments from compensation providers quickly. This is when follow-ups to the receivable accounts (A/R) comeinto the frame. A/R management helps healthcare providers run their practice efficiently while ensuring that the money owed is reimbursed as soon as possible.

Our account receivable follow-up team is responsible for looking after denied claims and reopening them to receive maximum reimbursement from insurance companies in a healthcare organization. It’s a thing of the past to have medical billing A/R and revenue cycle management handled by an internal team. Today it calls for our billing specialists with a broad skill set to take care of the A/R follow-ups.

Our medical billing professionals follow up on A/R in an organized way, typically achieved in three stages:

Initial Evaluation

This stage includes defining and evaluating the assumptions set out in the A/R aging study. Our team reviews the policy of the provider and identify which claims need to be adjusted off.

Evaluation and Prioritization

This process is performed after establishing the claims that are classified as uncollectible or those that the insurer has not charged with the healthcare provider according to the contract amount.

Collection

Upon checking all the required billing details such as claims processingaddress and conforming to certain medical billing regulations, the claims found to be under the carrier’s filing limit are re-filed. After recording payment information for unpaid claims, patient bills are produced as per the customer guidelines and then followed up with patients for payments.

Who Bills Patients?

Once a patient checks out, the medical report from that patient’s visit is sent to the medical coderwho abstracts and converts the details contained in the report into correct, accessible health code. This report, which also includes patient demographic information and medical history information, is called the “superbill.”

The superbill contains all the information necessary for providing medical service. It includes the supplier’s name, the physician’s name, the patient’s name, the procedures performed, the diagnosis and treatment codes, and other related medical records. This knowledge is crucial to the making of the argument.Once complete, the superbill is then transferred to our medical biller, typically via our software.

Where Does a Patient Call with Questions on Their Statement?

Patients can call our Patient Help Desk, where we have representatives ready to answer their questions and guide them through any process.

What Kind of Reports Do You Produce?

We provide daily/weekly/monthly/annual/ad hoc reports based on customer requirements. We also generate aging, collection, payer mix, denial, adjustment, and other reports as the client wishes (at the end of the month). Our reports are well detailed and contain the progress of on-going claims and a complete account of all activities performed. You can also export our reports and customize them with several grids for better understanding.

How Are You Different From Other Billing Companies?

Whether you’re in charge of general practice or specialty care, partnering with a reputable medical billing service provider will improve your cash flow and credibility. Therefore, with our wholesome service, you can keep up with regulatory compliances and be up-to-date. Here are some of the reasons why EMPClaims stands out from other billing companies.

Transparent Service

From the onset, we make sure you understand all the services we will render and all the associated costs. Our charging process and discount opportunities are well laid out, so you know exactly what you’re paying for and not get blindsided. There are no hidden charges, and you’ll see that our service can fit your budget no matter how small it is.

Meet with Deadlines

Meeting deadlines is essential for any company to enjoy continuous support from the client and avoid unpleasant experiences. Deadlines for providers, insurers, and insured alike are critical. EMPClaims alwaysadheres to schedules and delivers results, regardless of the specialties or problems involvedwithin the specified period.

Experience

We have been in the medical billing business for several years, giving our clients a satisfying experience. Wehave perfected the art of keeping customers happy and always strive to do better with each customer. We know how to efficiently communicate with insurance companies and independent payers to get reimbursements on time.

Responsive Services

We understand that speed and availability are the prime factors most healthcare providers are looking for. Revenue generation and satisfied patients are what keep healthcare providers running efficiently. Our team of experts is always available to respond to your inquiries so that you can provide your patients with the information they need.

HIPPA Compliant

We’re a fully certified HIPPA compliant company. It’s safer to partner with an ISO-certified provider consistent with the Health Insurance Portability and Transparency Act ( HIPAA) to safeguard your interest. This gives you peace of mind because our operations adhere to the HIPAA requirements, and all your confidential patient information is kept safe.

Want to find out how we do it? Read on, or contact us for a quick chat.

How is Your Fee Determined?

Our fee is determined by calculating a percent of all of the money we collect on your behalf. So if you don’t get paid, we also don’t get paid, ensuring our goals are aligned. We always strive to get your payments quicker. Our invoice is so much more than simply sending out your statements. Our team will support you and your employees with any concerns you may have about your claims, billing, practice, or patients.

Our billing system provides a database to which you have 24-hour access and is explicitly set up for your practice. Unlike other billing companies, our transparency and service are exceptional. We don’t charge any extra fees for re-bills, weekly reports, regular patient statements, or rejected claims. We charge one fee, which includes all of our standard services; no secret fees or charges are involved.

What is the Cost of Your Medical Billing Services?

We charge a flat percentage of the money that is earned for you andyour organization. The flat fee comprises payments from the commercial and government, capitation payments, co-payment, self-payment, and other payment forms. The American Medical Association states that outsourcing medical billing expenses will cost about 30 percent to 40 percent less than in-house services. The practice of an average physician using in-house billing systems spends 10 percent of collected revenue on billing related expenses. In addition to other services offered by EMPClaims, we also provide patient eligibility verification and an estimated amount of payment at no extra cost.

How Are You Able to Provide Medical Billing Service at Such a Competitive Rate?

First, we cut costs and improve productivity by doing it right. Our state-of-the-art proprietary software monitors every claim over the entire payment cycle, resulting in cost savings for missed claims. We also use state-of-the-art technology to obtain billing documents without ever leaving the physician’s office.

What Other Services Do You Provide?

Our Online Services Include:

Other Great Value-Added Features Include:

The ERA acts as a payment receipt and simplifies the detection of misplaced EOBs or checks in the system. Timely filing of claims for secondary insurance and re-filing of rejected or declined claims becomes simpler. At the same time, EFT offers a quick, safe, and efficient collection of electronic payments making a trip to the bank unnecessary.

What are the Benefits of Using Free EHR?

Although a fully functioning electronic health record ( EHR) system can cost as much as $25,000, EMPClaims gives every practicing physician a free EHR service.

practice management solutions into one unified kit. Services included in EMPClaims’ payment plans include Medical Records, free EHR — a full solution for practice management and flat rate Clinical Payment.

EHR provides Automated Billing, Scheduling, Claim Tracking, Record Management, Fax Functionality, Prescription Management, Model Modules, and Electronic Experience Information modules — all in fully-compliant and high-level security protection.

What Medical Specialties Do You Handle?

EMPClaims can handle the billing of all medical specialties including, but not limited to the following:

How Do I Send My Billing Information?

There are several ways, but the most effective approach is to export the data with EMPclaims EHR service. It helps the office record interactions electronically and, at the same time, give a paperless office environment. Another option is to submit it through a high-speed duplex scanner. It uploads all documents to the servers and enters the processing stream.

How Does EMPClaims Communicate with Their Clients?

All physicians receive an email address and a secure web log-in identification after signing a contract with EMPClaims for sending and receiving messages anytime. Our customer service team will answer your questions and our Patient Support Desk is readily available to manage insurance-related inquiries.

How Does EMPClaims File a Claim?

Approximately 97 percent of all the claims we file aredone electronically. For companies that are not currently set up to receive claims electronically, we manually use HCFA forms for claims submission. Many insurance companies respond electronically via an Electronic Remittance Advice (ERA), notifying EMPClaims, and the physician of payment receiptquickly. Electronic claim submission is the way to go because it produces results faster. We always try to encourage all our clients to adapt their systems to receive claims electronically.

What is the Benefit of Filing Claims Electronically?

Although the submission of paper claims can take anywhere from 90-120 days, the regular electronic filing of claims allows the insurance provider to reimburse within 7-21 days quickly. Physicians who use Integrated Services from EMPClaims will receive payments much faster in about 3-5 days. This drastic time reduction is due to the many features that we have in our Standard Medical Billing Agreement, including EHR, Eligibility Verification, ERA, and EFT.

Are There Additional Charges for Electronic Claims Transmission to the Clearing house?

There are no additional costs for forwarding electronic claims. No auxiliary charges are incurred for any of the services provided by EMPClaims. We don’t have a traditional “box mindset” of paying doctors for extra service they use on a la carte basis. Just a flat, setup fee, and low monthly service fee for contract life.

Where will Insurance Companies Send Payments?

They will send all checks and EOBs directly to your office. Since most insurance companies offer ERA and electronic versions of EOBs, and EFTs (Electronic Funds Transfer), physicians can collect EOBs and payments faster than a standard paper distribution, allowing for expedient and effective follow-up processes. Only hold the checks for physical copies, and send us scanned copies of the EOBs.

Do You Follow Up on Unpaid Claims?

Yes. We can reprocess the claim without requiring additional information unless the non-payment is legitimate, such as a deductible, capitation, lack of coverage, or duplicate invoices. For further information, EMPClaims will contact your office where necessary. When the demand remains pending, we must seek an appeal.

What is a "Soft Collection" Service?

We follow up on patient bills by sending a series of collections (up to 3), askingfor payment of the past due amount.

Can I Check My Billing Status/Balance?

The safe portal lets you check your billing status online, 24 hours a day, seven days a week. You can be sure all your billing information is safe on our secure portal.

How Long is the Setup Process?

After we have signed the contract, we may immediately start the setup process. Generally, the procedure takes 3 to 7 days for most physicians. After evaluating your procedures, we’ll provide a reliable estimate.

Are There Any Other Fees?

There are no hidden charges for click fees, post, business reply mail, etc.Although our procedure involves a time-consuming and difficult setup process to ensure that your claims are handled effectively, you only pay a flat percentage fee of the amount collected. Your payment covers services such as entering patient data, creating personalized documents, setting up a clearinghouse account, and assisting with the installation (if applicable) of a high-speed duplex scanner.

Where Can Patients Call If They Have Billing Questions/Inquiries?

AtEMPClaims,we do everything we can to ensure that your patients are pleased with the billing process. By using our Patient Help Desk, you’ll find highly trained service representatives to respond courteously and professionally.

Will I Be Required to Pay Any Other Costs or Charges?

We will not charge you extra fees for click fees, shipping, forms, company reply mail, etc., unlike other billing firms. All expenses are expressed in the flat rate. Our goal is to keep it easy for you, so you pay just the agreed sum.

What If There is Information Missing From Scanned Documents Sent to Your Office?

Forms with missing information are submitted to a Pending Transactions List (PTL), which your safe web log-in can access. You’ll be able to check and correct any missing info. This information is imported into our system immediately, thereby preventing delays in submitting a query.

Are There Any System Requirements to Use Your Billing Services?

You’ll need a high-speed, duplex scanner to access all the data along with an internet connection.

Conclusion

Billing medical claims are complicated, and there are countless methods for insurance providers to deny money to the health providers they owe.Your practice is at risk from the loss of hundreds of thousands of dollars in sales. EMPClaims will lower your costs substantially, raise revenue earned, and reduce lost revenue from denials and inadequate monitoring.

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