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We invite you to make a nice cup of coffee or tea and set some time aside to invest in the future of your clinic. Given our approach is unlike others available in the medical billing marketplace, we have outlined below some key recommendations that should help you during your due diligence. We encourage you to read through this in its entirety and call to schedule some time to go over your questions. You will learn why after 35 years serving the community, we experience very little turnover in customer relationships and that when we do, we're often asked by the same customers to manage their claims again.
By the way, Caramel Macchiato is our favorite!
how do you bill your insurance claims today?
Using Full-Practice Management? Outsourcing the data-entry portion of the billing process is only advisable for MD/DC/PT Pain Clinics needing ongoing professional consultation and legal protection for their specific needs and strict requirements. Unless you are an MD/DC/PT Pain Clinic that is outsourcing the data-entry portion of your claims to a specialist consultant who then sends your claims to us, the biggest problem with full-practice management is the inherent risk of losing complete control of your clinic. Many times we have had clients who were farming out their superbills and paying a percentage of collections for full-practice management before using our services. This was a huge and unnecessary risk on their part! Before using our services, some of our current clients lost all their patient records and a large amount of uncollected insurance because of lost data due to the billing company either discontinuing the full-practice portion of their business or the billing company going out of business entirely due to the large overheads necessary to run a profitable full-practice billing company. If this happens to your clinic, you will have lost all patient records, and your cash flow dry up immediately! Even if your full-practice management has the software capability for you to dial into their computers (or logon) and check patient information and post payments, if that data is not INSIDE your office, you have lost control and are making a huge unnecessary risk!
Sending Direct via Paper or Direct Electronically or Using a Clearinghouse? We call these methods of insurance billing the "Hamster-in-the-Cage" scenarios. Sending claims from your office directly to the insurance companies, even electronically, or going through a simple clearinghouse is still going to result in the National average denial ratio of 37%; BUT IT’S GOING TO DO MUCH WORSE THAN THAT! All carriers have different reasons for denials; and unless carrier-specific edits are performed, they will keep your money while your staff spends hours correcting one claim after another for resubmission and re-denial in an endless spiral of expensive man-hours. Because of their time spent doing this, efficient collection of the accounts receivables becomes impossible, and staying ahead of report filing is a future “dream.” Unfortunately, with that scenario, it would be more cost effective for you to “write-off” denials than to dig into the reason for them . . . and this is where thousands upon thousands of dollars are lost every year! That is bad enough, but it gets worse. After you finally receive your EOB denial, when you then correct that claim and resubmit it, the clearinghouse will probably charge you again for the very same claim. If there was only one error listed on the EOB yet the claim actually has five, you could spend months attempting to collect this one claim and end up paying six times the clearinghouse charge just for one single claim. Multiply that by the number of claims that leave your office on a weekly basis and then add it to the wasted man-hours. Even if you pay the clearinghouse a flat monthly fee, man-hours for corrections and resubmittals will end up costing you a fortune. This is what we mean by the "Hamster-in-the-Cage" scenario. Don't let this be your clinic!
When you send your claim to us, you NEVER have to send it to us again; and we work it with you until it is paid at no additional charge to you. It makes much more sense to send your claims to us, as we guarantee they will leave our office error free. While some software programs “claim” to do “editing,” a simple inspection will see that all they do is a “very basic scanning” for major omissions, leaving numerous errors which cause rejections and denials to flow into and pile in your office and create a mountain of paperwork on a regular basis. There is no state-of-the-art software available today that will edit totally and completely as the software used by Integrity Medical Billing. FURTHER, WE ARE CERTIFIED HIPAA COMPLIANT so you never have to concern yourself with that aspect of the new laws effective October 15, 2002; mandated April 14, 2003. Also, if your system does not print to the new 1500 form required June 1, 2007, it does not matter because ours does this for you. Furthermore, all NPI’s from our system are specific to carrier requirements so that you do not need to concern yourself with the differences.
Finally, if you are sending via paper, you do not need to spend money on postage, claim forms, HCFA envelopes, office supplies (toner, etc.), and the man-hours folding and stuffing envelopes anymore! Any claims that need to go out via paper, we pay for postage. Any claims that need a report attached, we send at no additional charge to you. If you send all your claims via paper now, you will no longer wait 60 days to receive a response from insurance companies. All your claims should be paid within 7 to 14 days!
other important information
When you are our client, you will see why most of our providers feel as though we are working for them on a full-time basis, yet they pay no employee benefits, are responsible for no 941’s, and have at their fingertips more than 35 years years of consulting experience and direct contact with all insurance companies’ current edits to know when they change or add anything that would cause your claims normally to deny.
Our software converts your claims to HIPAA-compliant claims regardless of what software you are using. So there's no reason for you to purchase any other software than what you already have in your office!
Our software makes sure your NPI #’s are in the appropriate fields for individual #, organizational #, Referring physician #, and facility # and sends these “carrier specific” inasmuch as Medicare requirements and commercial company requirements are totally different.
All of your claims are edited with carrier-specific edits. It is OUR job to keep our edits in our software updated weekly with every single insurance company, leaving you NEVER having to worry whether or not your software vendor is up to date. You no longer have to pay your software vendor regularly to download their updates, if, in fact, they have any at all.
We are also able to write specific edits into our software for your specific clinic based upon your software flaws and/or specific clinic needs that would be different from other clinics (i.e., patient assignment of benefits!).
We also work directly with your software support in the event your software has errors either initially or whenever you software vendor's updates throw your system off (a normal occurrence with most software vendors, especially with their “updates”).
Claims are then processed DIRECTLY to Emdeon, BCBS, and Medicare. Due to the HIPAA Mandate, most insurance companies are now electronic. However, all claims going to insurance companies who are not yet electronically approved, after editing, are dropped to paper, folded, stuffed into envelopes, stamped, and hand-delivered to the Post Office by Integrity Medical Billing personally. Other billing companies will farm these claims out and they are totally unaware as to when these claims are actually folded, stuffed, stamped, and mailed. Further, you pay NO postage, no envelopes, no printer toners, and no man-hours for folding and stuffing, etc.
Claims missing information or questioned by us are put on hold while all others are immediately processed. A specific request for that missing information is immediately faxed to you; your office personnel will simply fill in the missing blanks and fax back to us as well as correct your system for future claims. Upon receipt of that information from you, we correct the claims we were holding and process those claims for immediate payment. Once you have transferred your batch of claims to us, you NEVER have to send that claim to us again and you are NEVER charged for future work performed on those claims, regardless! We never tie up your insurance clerk as other billing companies do with correcting/rebilling, correcting/rebilling, correcting/rebilling; Quite the contrary, we work with your insurance clerk on each bill until it is paid in full by the insurance company.
Correct place of service errors are immediately corrected by us and claims processed without hesitation; we never kick these simple errors back to your office for correction and rebilling; these are common, every-day errors in every busy office and should never hold up a single claim.
We manually attach reports to any and all claims for which reports and/or CMN’s are required according to your specific clinic policies at no additional charge!
Electronic kickbacks are handled by us rather than just forwarding on to you; this saves numerous man-hours of work on the part of your insurance clerk and notifies you immediately of valuable, money-saving information (i.e., no coverage for a particular patient, insurance cancellation, etc.).
We make any and all after-the-fact corrections such as change of insurance company for claims already submitted, and we do these corrections and resubmissions AT NO ADDITIONAL CHARGE TO YOU.
We monitor Emdeon rejections, BCBS rejections; and paper claim returns; each are researched, corrected, and resubmitted by us at no additional charge to you.
We follow up with Medicare and BCBS regarding your particular status with them to be sure all is perfect as well as adding and deleting doctors/associates who may come to and go from your clinic.
We help you write specific letters and/or make specific calls to insurance companies when they have presented a problem in paying claims and/or state they do not have claims for which we have confirmations of receipt.
We stay current on and keep you advised of insurance company changes so you do not have to do so (i.e., Medicare, BCBS, Commercial, etc).
We are available for specific consultation (i.e., which insurance to bill when the same patient is involved in two separate car accidents, etc).