How does it work?
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- I'm not located in St Louis, can you still do my billing?
- Absolutely! Currently we bill for providers in several states. Unless there is a state law in your state requiring that your billing service be in-state, we can do your billing. Note: We regret that we cannot offer services to professionals in Michigan or Nevada.
- How does it work?
- It's simple. You send us
info and we verify benefits. You fill out a
daysheetdaily or weekly
and we bill charges. When you receive payments, you fax or mail the
accompanying Explanation of Benefits (EOB) form to us. We take
care of the rest!
- How much does it cost?
- Please visit our Rates page
- Do you specialize in mental health?
founder, Susan Frager, is a licensed clinical social worker and a former
case manager at what is now Magellan Behavioral Health.We believe that
mental health billing is distinctly different from other types of medical
billing. For one thing, often the mental health payer is not always the same
as the medical payer. Authorizations may be handled by a 3rd party. The
co-payments listed on the card -even in the age of "parity" - don't always
apply to mental health! From discussions with medical billing colleagues at
conferences, we frequently hear from medical billing services that they
don't want to handle mental health because the practices are "too small," or
"it's too much work," or "there's just not enough money involved in the
claims." We proudly specialize in mental health billing. It's our expertise
and our passion. You deserve a billing service that understands your needs
and doesn't try to fit you into the mold of a big medical or surgical
- I don’t participate with insurance or managed care companies but patients want me to submit claims. Can you do that for me?
- Our services can be used regardless of your network status with insurance companies.
- Can you do patient statements?
- We always do patient statements. Statements are an integral part of our services, and are included as part of the overall cost of the billing services. If necessary, we can also send statements to patients’ attorney, church, or whatever 3rd party is the guarantor for the account.
- I lose money on sessions not being authorized or because patients use more than their yearly maximums. Do you keep track of authorizations?
- Absolutely! How can you expect to get paid if we don’t? We have heard of billing services that don’t keep track of authorizations, and for the mental health specialty, that is simply not acceptable. Each time we send out claims, we send you an Authorization Report dated through the last day billed. It lists patients, name of insurance company, auth #, # visits used, # visits authorized, start & end dates, plus a comments field, usually populated w/# visits per year. This will help you keep your authorizations current.
- Can my patients call you directly if they have questions about their insurance?
- On all our patient statements our toll-free number 1-(888)-530-9833 is
listed. We encourage patients to call us directly if they need to. That way
you don't have to waste session time discussing money.
- Are you able to check benefits ahead of time so that I know how much to charge my patient when s/he comes in for the first time?
- Yes, if you get us the information in a timely manner. We believe that thorough benefit verification is an absolute MUST. Why wait 4-6 weeks for the first claim to be paid before you know how much to charge the patient? Our experience shows that by then the patient may be gone and it’s a lot harder to get the co-pay/coinsurance/deductible than if you collected it at the time of service. Or, if the patient is still in treatment, after 4-6 weeks they might have built up a large balance which then becomes an obstacle or a therapeutic issue. Our goal is to get you as much information as possible, to help you collect as much as possible at the time of service. This will maximize your income and reduce your costs…which is what good practice management is all about.
- What are your hours? Will I be able to reach you when I need to?
Typically someone is in the office from 9 am central time to 6 pm central time,
Monday through Friday. Our fax machine is on to receive faxes 24 hours a day, 7
days a week.
- How do I tell you when claims are paid?
- You simply fax or mail the Explanation of Benefits (EOB) statement that
accompanies the insurance check. Or, we can set it up so that the EOBs are
received by us electronically.
- Do I retain control over my money?
- Absolutely. We never receive “live” checks. Patient and insurance checks are payable to you and received at your address, just as they are now. Some billing services insist that your money go to a lockbox or even be deposited in an account to which they have access. They say they do this for your convenience, so that you don’t have to fax/mail EOB’s. While this may be a side benefit, in reality there’s a mistrust that you won’t report all your payments. We believe that we are your practice management PARTNERS. If there’s not trust between us, what’s the point? Under-reporting serves no one: for one thing, you won’t get the full benefit of our services by under reporting, and #2, we typically find out from a patient or insurance company anyway that there has been a payment. Our experience has been that practitioners are so happy with our services, it doesn’t occur to them to under-report.
- I am not able to keep track of which claims aren’t paid, and then I lose money because things aren’t submitted “Timely.” Will I have to keep track of which claims are paid, or do you do that?
is what you have hired us for! Every week we generate a "Claims Aging Report."
This shows us all your outstanding claims so that we know what to follow up on.
We also check the clearinghouse for rejections on a daily basis. If we have to
resubmit, "timely" filing isn’t an issue when you submit claims electronically
because the clearinghouse can provide proof of "Timely" submission. And for this
reason, insurance companies tend not to "lose" electronically submitted claims.
And for paper claims or EAP claims, we follow up in enough time to resubmit, if
- How often do you bill to insurance?
- As often as we can! Frequent billing ensures a steady cash flow for you!
- What is the expertise of your staff?
- Visit our About Us section.
- Will I have someone personally overseeing my billing?
- Yes. A lot of billing services use an “assembly line” approach. In other words, there is one person that verifies the benefits, then another person enters all the charges and sends out the claims, then a 3rd person posts the insurance payments, and a 4th person develops and sends out patient statements. This may be necessary in a big billing service, but we are small enough to give you personalized attention.
- Can you process patient credit card payments?
- Yes. We partner with InstaMed to offer this
service. Patients can either call our office with their credit card numbers
or fill out a form at your office. They can also go to a secure site online
to pay. There's no equipment to buy or rent...don't lose money just because
your patients don't carry a checkbook! Note: the InstaMed service is at
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- I’m hopeless with computers! Do I have to know a lot about computers?
- No! All you need to know how to do is operate a web browser or email.
- Do I have to buy expensive software?
- There is no software you have to buy or install. All you need is a web
- Do you bill electronically?
- Yes. Our clearinghouse is Capario. Please keep in mind some mental health insurance carriers
(EAPs, mostly) still do not accept electronic claims, but for the most part
our claims are submitted electronically.
- Are you HIPAA compliant?
- Of course. We are considered a “business associate” and when you sign up for the service, you receive a “business associate” contract to add to your HIPAA compliance plan.
- Are you submitting NPI compliant claims?
- As of May 9, 2007 100% of our claims are submitted in an NPI format.
- Are you submitting ANSI-5010 claims?
- Yes, as of January 1, 2012.
- Will you be able to convert to ICD-10 when it is required?
- Yes. We will offer you full support for the conversion.
- Insurers/Medicare is forcing me to accept electronic deposits & remittances.
Can you do that?
- Yes. We can electronically post your 835 remittance files,
and in most cases, it is preferable because that leads to faster patient
- What billing system do you use?
- We use Healthpac, a program
that is one of the billing industry's largest - many large medical billing
services, hospitals, and medical practices use the same software. However,
it has adapted beautifully for the special challenges of billing for mental
health, psychiatry, psychology. Healthpac is unique in that the programmers
solicit feedback from the users and tailor upgrades based on user input. We
get unlimited upgrades, so you always have the latest version - at no extra
cost! And in addition you get a robust program with lots of reporting
capability, and unlimited technical support (no extra charge) which helps us
serve you better. Customization is also available for special needs
(although this may come at additional charge). If you require an online
scheduler, Healthpac can provide it or build an interface to your existing
system (although at additional charge).
Special Billing Concerns
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- Can you bill for psych or nueropsych testing?
- Can you bill if I am a MD?
- Of course.
- Can you bill for employee-assistance (EAP) visits?
- We routinely bill for EAP visits.We understand the inherent challenges in employee-assistance billing: it’s not standardized, the codes vary widely, and frequently you can’t use a HCFA/CMS-1500 form. We take care of everything but reporting clinical information!
- Can you bill for SAP evaluations?
- Can you bill Workers Compensation?
- I practice in nursing homes rather than an office, can you bill for me?
- Can you bill patients’ Health Savings Accounts?
- Yes, although some Health Savings Accounts require that you accept major
credit cards. To do this you must either be linked with our merchant
partner, InstaMed, or a merchant vendor of
your own choosing.
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- Can you extend authorization end dates?
- Yes. This service is not included in the standard billing package, but yes, we can do this for an extra charge. If you are not organized, the cost might be worth it to make sure your claims get paid. We work with you to determine what your needs are and how to organize yourself to make sure that as many of your claims are paid as possible.
- I would like to negotiate with insurance or EAP companies to try to get better rates. Can you help me with this?
- Yes. Some companies are more willing to negotiate than others, and success frequently depends on criteria outside our control, i.e. network needs, your location, your specialties, company policy, and so forth. But if this is a service you are interested in, we will first consult with you as to the feasibility of successful negotiation.
- I am so tired of filling out credentialing & re-credentialing applications! Can you do this for me?
- Certainly. We can do either paper credentialing, CAQH, or online at the payer site, as needed. The average amount of time is 1-2 hours per document after all information about you and your practice has been gathered.
- Can you help me find managed care panels to apply to?
- Yes. This is a separate service from our billing package. We have extensive experience in partnering with clinicians to discover the right blend of managed care participation and non-participation.
- Can you review my managed care contracts?
- Yes. This is a separate service from our billing package. We have read hundreds of managed care contracts and can explain to you the pros/cons of signing them because we are familiar with the frequent terms and conditions used in managed care contracts.
- Can you consult with me on how to market my practice or to start a private practice?
- They never taught you the business of private practice in graduate school, did they? Yes, we offer consultation which does not require the use of our
- Can you handle past-due accounts and outstanding claims I currently have?
- Yes. However, the fee for handling outstanding patient accounts or claims
from dates of service prior to our start date will be separate and distinct
from the regular billing package. It will also be significantly higher. This
is due to the difficulty in getting claims paid that may have been billed
incorrectly, not timely, not authorized, etc., and patient accounts that may
have been allowed to age without prompt billing, faulty addresses, etc.
- Are you a collection agency? Will you work with collection agencies?
- No, we are not a licensed collection agency. We can't report delinquent debt
to credit reporting agencies nor do we ever contact patients by phone or
email about past due balances. Yes, we can provide information/reports to a
collection agency if you choose to employ one.