3 Easy Steps to Increasing Profitability:

1. Provide complete, accurate information to the insurance carrier.

2. Regularly negotiate reimbursement fees with your payers.

3. Don't make inappropriate or unnecessary adjustments to claims.

Frequently Asked Questions & Answers

25 of the most commonly asked questions!

Q. How do we get the necessary information to you?

A. There are several ways for your office to send in your billing, including the following:

Standard Mail - just place your documents into a secured envelope and mail to our main office.

Courier - you can take advantage of our courier services and don't worry about it! Our courier will pick up your billing, at pre-scheduled dates and times of your own preference) and deliver it to our office for you! SAME DAY SERVICE!

Federal Express Services - offers many different deals to small business owners, establish your own account quickly and easily today! For more info just go to www.fedex.com.

Q. How often should we send our new billing to you?

A. As often as you choose to! We personally recommend, however, that our clients send us their new billing consistently on either a daily or weekly basis.

Q. What do information is needed in order for your office to generate a claim on our behalf?

A. We normally require the following (may vary):New Patient Information Form

A copy of the patient's insurance card or WC ID card (front and back)A copy of each of the patient's superbills (treatment form)

Q. How do we report when treatments are rendered, so that you are able to generate a claim on our behalf?

A. We must receive all applicable superbills (treatment forms), which have been completed. This form must contain the following (may vary):

Patients name

Name of insurance carrier

CPT codes

ICD-9 code(s)Referring physician's name and the referral #

Any/all applicable modifiers If your practice does not currently use this type of form, we can custom design one for you.

Q. Do we have to report the insurance payments received in our office to you?

A. Yes! It is vital to your practice that we receive this information, so that we can enter the insurance carrier's payments and generate the necessary patient statements for those accounts which still may have a balance due. You can copy and mail these remittances, send them via fax, or have our free courier service pick them up with the other information.

Q. What happens if we accidentally omitted any of the information contained on the required forms, and we already sent them to your office?

A. You will receive a report indicating that the claim is does not contain enough information to be processed by the carrier, listing exactly what is missing, which is normally faxed to your office immediately. We do this as a courtesy to you and your staff, to assist in gathering the information quickly, and to avoid timely filing deadlines that are imposed by many insurance carriers.

Q. How do we report payments received from our patients, for both co-payments and patient billing?

A. You can easily report a patient's co-payment, made at the time of service, on their superbill (treatment form) for that day's treatments.

You can also report all of the patient's payments, received in the mail, by keeping a Payment Log. A payment log enables you to report all payments received in your office, using one simple form. If you do not already use this type of form in your practice, we can custom design one for you.

You can also report all of the patient's payments, received in the mail by making a copy of the check and attaching it to their patient statement remittance (if returned).

Q. How often will our patients be billed?

A. Any patient in our system will receive a bill for any balance due, once a payment has been received by their insurance carrier, if you have contracted for this service. Patients are billed on a monthly basis usually. Payment Plans can be easily accommodated also.

Q. How do you handle non-payments from an insurance carrier? (denials, etc.)

A. We must first determine if the denial, whether in part or in full, is valid. If the denial is valid it must be written off. If the denial is not valid, as in many of the cases, we will request that the carrier reprocess the claim. Unfortunately, many carriers will require that the claim be resubmitted on paper via snail mail, and additional charges may be invoiced to your account as a result.

Q. How do you handle non-payments from a patient?

A. We will send out no more than four statements, and make follow up phone calls (if patient support services have been included). After 120 days we recommend that the account be turned over to a collection agency, and that the patient be denied future treatments until their account has been paid. If you are not already affiliated with a collection agency near you, please let us know.

We strongly recommend that an additional fee be applied to each account which has not received a payment within a 30 day period.

Q. Do we have to collect every co-payment?

A. YES, YES, YES! Not doing so is considered to be fraud and/or abuse, and it is also a possible violation of the contract entered between the patient and their insurance carrier...and even the provider and their own contract with the insurance carrier!

Q. We are having trouble tracking authorizations, can you help?

A. Authorization Tracking is best done in-house, by the person who handles the scheduling. For an additional charge, we can track your authorizations as we receive the information from your office, and provide you with reports that warn of expirations on an as needed basis.

Q. We prefer to bill our own patient's, but we are interested in obtaining insurance claim processing services from you. Does your company offer this service?

A. We sure do! Please keep in mind however, patient billing is best performed by your biller, who already has access to all account balances and other additional information. If we are already handling the insurance end of things, it only makes common sense to let our system automatically generate the claims on an as needed basis!

Q. How many clients are you equipped to handle?

A. Our staff size is accommodated to meet the needs and volume of our own business. We will consider any practice, regardless of their size, and ensure that we will be prepared to handle all of our clients needs in that process.

Q. We've never outsourced our billing before, and we are leaning towards taking on the responsibility of handling this area ourselves. What services can you offer to assist us in this process?

A. Our consulting services would be a perfect solution! We can assist you with software selections, staff training, organization, office policy & procedures, compliance, and more!

Q. Why will you not accept a superbill that is missing information,instead of just looking up the patient's history in the system?

A. This is considered fraud and abuse! All of the required information must be included on the superbill, we cannot "guess" or "assume" on your behalf exactly what services you provided, etc.

Q. We are receiving many denials which cite that the patient was not covered at the time of service, resulting in many write offs, how can we prevent this from happening in the future?

A. Immediately start performing Verification of the patient's Benefits! If your staff is not already performing this necessary evil, they should be! This is another valuable service that we offer, even if you are not contracted for our full billing services!

Q. We just do not have the staff to keep up with the old accounts receivable. Do you offer A/R Recovery services?

A. We sure do!

Q. Can you code our superbills for us?

A. We provide coding services, providing that the documentation provided to our staff support the coding requirements.

Q. What specialties do you currently handle?

A. At the present time we specialize in Orthopaedic's, Family Practice, General Surgery, ENT, Urology, Radiology and Podiatry. However, because we are a claims processing specialist we can accommodate most any specialty.

Q. How much are your services and what methods of payment do you accept?

A. At the present time we only accept cash, checks, or money orders. However, we are in the process of establishing a merchant account and will be accepting Mastercard, Visa, or American Express very soon!

Q. How fast can you get us up and running?

A. We can start immediately! From start to finish it can take an average time of one day to 1 week, depending on the individual circumstances surrounding each client. We can give you a more specific time period once we have had the opportunity to analyze your individual practice.

Q. We just lost our biller and desperately need someone to help us out until we are able to replace her, can you help?

A. It may be possible for us to assist you in replacing a staff member. Alpha networks with other billing centers and healthcare professionals across the United States!

Q. I'm thinking about starting my own practice, can you help me?

A. Yes! Starting a new practice is an exciting experience, and often a little scary too. Our services are designed to keep it an exciting experience for you, and to do everything in our power to ensure it will be a profitable one for you too! We offer a variety services, which can benefit most any practice, in a variety of different ways!

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