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Outsourced Billing Services FAQ

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Learn the answers to some of the most commonly asked questions about outsourced billing services for behavioral health and medical care providers!

Frequently Asked Questions

How does your billing service work?

Based on your needs you will be assigned a specific and dedicated billing specialist that you will work directly with. Then on an ongoing bases, usually weekly is preferred, you would send us new patient information, day sheets, payment entries and EOBs. We will enter all of your data, send insurance claims (electronic when possible), create and send patient statements, track authorizations, follow up on unpaid insurance and create and send to you variety of reports. You will receive patient payments, insurance payments and explanations of benefits (EOBs).

Specifically, the process is as follows. First, you will send us a day sheet or charge sheet that lists the client that was seen, the date they were seen and the service that was provided. We will then enter that information into our system and send the claims to the insurance company for you. You will receive any payments and all correspondence directly from the insurance companies. You send us the all of the EOBs, remittance information and correspondence that you receive from the insurance company so that we can post the payment or denials. We will then follow up on unpaid claims or denied claims. We then charge you a monthly percentage based on the amount that you collected (not for the amount charged, but the amount of payment collected for your services).

How often do we need to send you patient information?

We prefer weekly or daily. The important thing to remember is to send the patient information on a regular basis. This will help create a more consistent cash flow for you because we will bill on a regular basis. However, it is all dependent on how consistently we receive the data from you.

In what format do we send the client data?

We have a secure fax line for your billing specialist that you can use when sending you day sheets. You also have the option to send the data via encrypted email.

What information needs to be on the day sheets?

There is some basic patient information that needs to be sent to us for billing such as name, therapist name, the service, a different charge amount, etc. We have a template that our billing specialist can send to you upon orientation. We want to be able to create as little work for you as possible, so it is likely that we will be able to use a current form or document that you already use to track your services. You will be able to review this with your specialist.

How long does it take for us to get paid?

This can vary for different insurance companies. For most outpatient claims, from the time we receive the data to the time the claims are sent, we have averaged payment within 7-15 days if it is filed electronically. If the claim is sent by paper, then the turnaround may be 14-21 days.

Please keep in mind, there is no guarantee for a timeline of how quickly you will get paid or if you will ever get paid on certain claims. However, our billing specialist will work diligently to make sure you do get paid. If the provider isn’t getting paid, then neither are we.

Also, if it’s the first time billing to an insurance company, it can take longer if additional information is requested to establish your organization with that company.

How often do you send reports? What if I want to check on a patient’s balance due?

We have several reports that are available to you. We send them on a weekly or monthly basis unless you request them more frequently. However, if you need to know a balance immediately, you can call one of our billing specialists and they can get that information to you as soon as possible.

What kind of reports do you send?

The kind of reports we send depends on your needs. We have patient statements, accounts receivable and aging reports, outstanding claims, authorizations,
monthly totals and provider totals, to name a few. There are other reports we can send in which our specialists will work with you if you have other specific reporting needs.

Do you send the invoice/statements to the clients, or do we?

We will prepare the statements and send them to you. It is then your responsibility to send the statements to the clients. A lot of our customers like that because they can add a cover letter or other specific information or stationary from their own organization. We do not make direct contact with your clients.

What billing information do I need to send to get started?

First, we will send you the transaction service agreement and HIPAA agreement. There will also be a worksheet that will ask a series of questions for us to get started. These questions include your business information (name, address, tax id and NPI), provider information, client information (so we can start tracking in the system), active balances, current charge codes and unpaid claims.

Do you track authorizations, and how are we notified?

Yes, we do track authorizations. We notify you via phone and/or a report when we see that authorizations are getting low. This is another reason why it’s important to consistently send us data.

What about past claims that are still unpaid? Do you “back bill”?

We are able to resubmit back billing and outstanding claims. However, we will make the current and newest billing a priority above the back billing because we want to make sure those services do not turn into back billing. Some back billing will be dependent on the timely filing restrictions with a specific insurance company. We will re-submit any outstanding claims and proceed with our standard follow-up procedures with the insurance company or Medicaid, etc.

How do you track payments?

When you receive any payment for services, such as self-pays, EOBs or contracts, you send us an indication of those payments or a copy of the EOB. We will then update the client records.

Why would I send you my self-pay info if you’re not sending claims on them? Wouldn’t that potentially waste money?

Our service is not just about sending claims to insurance for you, but to really act as a bookkeeper for tracking all payments for the services you provide for your clients. You certainly have the option to withhold information, just as long as you understand that the reports that we send to you may not be complete. We cannot ensure accuracy for your internal purposes if information is not sent to us.

Can you bill for Medicaid?

Yes, we are partnered to bill for Medicaid in several states, and we are in the process of being set up for all 50 states. Contact us to let us know what state you are billing from, and we can verify where your state is in the process.

I’ve never billed for insurance or Medicaid before, its been all self-pay. However, I’d like to start. What can I do to get set up for this?

For insurance, it depends on what status you would like to bill under for these insurance companies, as in “network” or “non-network” provider. There are some benefits with each. To bill as a non-network provider, there is no setup required on your end, as Orion healthcare Technology will handle these steps. However, to be an in-network provider, you would need to apply to each of the insurance companies that you want to be included in to be accepted. While we can bill for Medicaid, we do not assist with your organization’s (or provider’s) actual Medicaid certification.

What’s the main difference between billing as a networked or non-networked provider?

There are several differences, but it mainly comes down to the percentage you can get reimbursed for. Generally, there is a higher reimbursement rate for networked providers than non-network, such as 70% vs. 40%, respectively.

How do I sign up for your service?

We have two forms that you need to sign off on. One form is the business associate agreement. This is signed by us and you, and covers HIPAA policy and procedures. The second form is the service agreement, which indicates the terms of the service, percentage charged and form of payment. You can choose from monthly automatic deductions from a credit card or bank account, or we can invoice you for the amount owed each month. These forms also include the initial requested information questions and worksheet about your organization and billing needs that will assist us in assigning a specialist to you.

Do you perform pre-cert/authorization calls?

That is a different relationship that the provider has with the insurance companies. Therefore, we leave that part up to the provider. However, we can provide additional training to implement certification and authorization tasks in your organization if requested.

Do you perform calls to get benefits from insurance companies?

This step is left up to the provider to coordinate.

Can you bill for medical services?

Yes, we do bill for medical services. While we work a lot of behavioral health clinics, our outsourcing billing services are for all healthcare providers. For instance, we also work with Emergency Medical Services (EMS), physicians, primary care practices, and more.

I’ve never billed before and don’t know anything about billing. How can you help me?

We have different levels of the billing service we provide that depend on your goals for billing. Please contact one of our representatives to learn the best options for your organization.

How do I know what billing codes I am supposed to use?

We have a certified coder on staff that will allow us to suggest which billing codes you should use. As an additional service and
for an extra cost we can do the following:

  • Analyze current services and assign the appropriate CPT
    or revenue codes.
  • Verify with state medical assistance programs for payable
    codes and determine which services you provide
    are billable and make suggestions for
    improvement.
  • Obtain, review and provide feedback on the state’s
    payable fee schedule
  • Develop a master charge list by creating a crosswalk of
    services offered with the appropriate billing code and
    description

Contact Orion Healthcare Technology Today

If you have additional questions or would like to get started with our outsourced medical billing services, Orion Healthcare Technology can help! Fill out our online form today or give us a call to speak with one of our representatives.

 

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