What information is needed from the practice to process claims? Is there a required format? Are scanned documents permissible, and if so, in what format? PDF, Tiff or jpg?
In order to process claims we will need a registration or intake form, legible photocopy of front and back of patient’s insurance ID card, and a super-bill or encounter form with CPT Codes and ICD-10 codes (Multiple CPT and ICD codes on one encounter must be cross referenced to each other). We can accept scanned documents in either PDF, Tiff or jpg formats.
How quickly are charges processed after information is received from a physician’s office?
Charges and payments are posted within 72 hours of receipt.
Which insurers are billed electronically? Is a clearinghouse used? How often are claims processed?
All carriers that accept electronic claims will be billed electronically. Claims are submitted directly to Blue Shield and Medicare and Emdeon clearinghouse is used for Managed Care and Commercial carriers.
How are denials handled?
Denials are worked on at the time of payment posting. When additional information is needed from the client, a Request for Information Form is utilized. The form is dated, filled in with the specific information necessary to adjudicate the claim, and faxed to the client. After faxing, the client is called to verify receipt. When the requested information is returned, the data is entered and the claim is resubmitted. If we do not receive the requested information back by the 10th to 15th of the following month, the original paperwork and fax sheets are mailed back to the owner of the practice, with a letter explaining the contents, and why he/she is receiving it.
What are the collection policies?
MRA will submit the first claim to the carrier. We have a Transmittal Report, when run at the appropriate time interval from transmission date, will report those claims which have not been paid (i.e. Medicare pays in 21 days, on day 25, the Transmittal Report is run, and phone calls are placed to the carrier. Necessary medical billing information is collected to re-submit the claims within 72 hours, and the Transmittal Report is run again 25 days later. If the claim remains unpaid at that time, the balance is shifted to Patient Status, with an appropriate message appearing on the Patient Statement. Three patient statements are mailed to the patient, with a “Collection Letter” sent with the 3rd. If 30 days from the 3rd statement passes, the balance is moved to a “Client” status, and the client is sent a report of those patients for disposition (i.e. Write Off Bad Debt; send to Collection Agency; Client staff will speak with patient; send to Attorney; etc.)
Will our practice be assigned a specific billing contact? How are the responsibilities within the billing service divided (charge entry, accounts receivable follow-up, collections, customer service representatives, etc.)?
MRA employs a team approach. The Charge Entry Team is responsible for the data entry of patient demographics, new charges, and those new charges requiring additional data from the client, as well as claims submission and auditing of electronic submission reports. Our Payment Posting Team provides payment posting and preparation of claims denial for our third team. The AR Team is responsible for denials, open claims and the filing of appeals.
Can a list of references be provided?
Yes, we have many reputable sources that will confirm our abilities in both physician billing services, and medical bookkeeping.
What is the company’s turnover rate?
MRA has employed each member of our current staff of Account Managers for 3 to 12 years. Each of these individuals came to us with prior medical billing service experiences.
How many “downtimes” does your system typically have and has there been any impact on the client ?
MRA has never been down more than one business day since our inception.
What are the computer back-up protocols? Are tapes taken off site over night?
We have a tape back-up system, which automatically backs up every evening. We use a different tape every day of the week. The other four days’ tapes are stored in a fireproof box. Upon IT staff arrival in the morning, the backup software will indicate if the backup was successful (logs prove a 98% accuracy over the year). The tape is removed, and is taken home with the IT staff member, who has a fireproof box at home. Once a month, a complete system back-up is performed, and that tape, for the entire month, is taken off the premises.
- Fee schedule analysis and recommendations
- Physician or physician staff coding training
- Alerts about reimbursement trends from an insurer (i.e. services included in capitation,denials of code(s), bulletins, special reports, etc.)
- Benchmarks for similar medical bookkeeping practices
- Review / audit of the physician’s documentation practices, and other medical credentialing.