FAQs

1. How much do you charge?

“Our most common pricing model is a percentage of collections, which aligns our success directly with yours. The exact percentage may vary depending on claim complexity, numbers, and volume. For smaller practices, we also offer flexible alternatives such as a per-claim fee or a flat monthly rate, cumulative charges, and a charge per claim.

After reviewing your specific workload, we’ll recommend the structure that provides the best value for your practice. To give you peace of mind, we provide a clear, transparent rate outlined in our business service agreement with no hidden fees or surprises.”

2. Do you charge for denied claims resubmission?

“No, denied or rejected claims are included in our service. We track, correct, and resubmit them as part of our standard follow-up process. If a claim cannot be paid due to contractual reasons, we will inform the practice and assist them in correcting their process.”

3. Do you handle patient statements and collections?

“We provide patient statement services on your behalf and offer secure, convenient payment processing options. For collections, we can either manage the process directly or work seamlessly with your preferred collections method.”

4. Which software/EHR systems do you work with?

“Our proprietary billing software, MedOffice, can integrate with electronic health record (EHR) systems to ensure smooth and secure patient and claims data exchange. There’s no need to change your existing EHR for us to do your billing. We simply just need to receive the claims data in some way, and we’ll take it from there.”

5. Do you provide real-time reporting and access to claims status?

“Yes, our company can provide real-time claim balance and monthly collection reports, so you always know exactly where your revenue cycle stands. We also offer a secure access portal to your account in our software, allowing you to check activities 24/7.”

6. How often do you follow up on unpaid claims?

“We begin follow-up on denied claims as soon as the denial is received. All denials are considered high priority and are addressed immediately. We understand how insurance companies operate, and we work diligently to challenge and resolve denials to ensure you receive the reimbursement you’re entitled to. Our team also runs claim balance reports weekly to ensure all claims are paid on time.”

7. What kind of reports will I receive?

“Our standard monthly reporting package includes an insurance aging report, a patient balances report, and a total collections report. In addition, our system offers a wide range of reports that highlight financial performance, aging, and billing trends, giving your practice a clear and accurate picture of its financial health at any time. If you ever need specific data, simply let us know and we’ll provide it promptly.”

8. What is your billing process?

“As soon as a claim is received, it’s submitted electronically within 48 hours, typically 24 hours. Once submitted, our team confirms the insurance company has received and accepted the claim for processing. If there is an initial issue with the claim due to invalid patient data or coding errors, we will try to resolve it on our own or contact the practice for the correct information. Once a claim is accepted for processing, our team will keep track of the time it was received and make sure the claim gets paid on time. Since we run balance reports weekly for following up on claims, no claim gets ignored in the process. Once an ERA is returned for the claim, it’s carefully reviewed to ensure accurate processing. If there are any issues with the claim, it is addressed immediately. The ERA data is input into our billing system, and patient statements are generated monthly.”

9. Who do we communicate with?

“You’ll have a dedicated account manager and billing specialist as your primary point of contact. They’re accessible by phone during business hours, email, or scheduled calls. While we guarantee responses within 24 hours, most inquiries are addressed the same day. In addition, we recommend holding a standing meeting at least once a month to review performance, address questions, and identify opportunities to further improve and enhance our service.”

10. Which clearinghouse do you work with?

“Our billing system can work with any clearinghouse. We can set up a clearinghouse for your account or use your existing clearinghouse. Our preferred clearinghouse vendor is Claim.MD.”

11. Are you ready to do billing using my billing software?

“Yes, absolutely. We can log in and use your existing system if you prefer our team to do the billing in there.”

12. How do we send you the superbill/claims data?

“You can securely send superbills in several convenient ways:

• Secure email or fax
• Directly through your EHR to save you time and money
• HIPAA-compliant shared folder method, such as Dropbox, for easy document transfer.”

13. How is your onboarding process?

“Our onboarding process is designed to be simple and efficient. Once the contract is signed, we’ll provide you with a setup checklist so we can begin right away. Your dedicated billing specialist will configure both the billing software and clearinghouse simultaneously, allowing claims to be submitted as soon as they are received. In many cases, claims can begin processing within just a few days, though some payers, such as Medicare and Medicaid, may require up to 10 days due to longer EDI(Electronic Data Interchange) approval times. The sooner the setup information is provided, the sooner we can have your claims flowing seamlessly.”

14. Can you verify insurance eligibility and benefits?

“Yes, we offer insurance eligibility verification and benefits checks before the appointment, reducing denials and improving patient collections.”

15. Do you assist with prior authorizations?

“Yes, we can support prior authorizations as an additional service, helping reduce administrative burden for your staff and improving approval rates.”

16. How do you ensure compliance and data security (HIPAA)?

“We strictly adhere to HIPAA guidelines and use secure, encrypted systems to protect patient information. Your data is always safe and confidential with us.”

17. What are the services included in the Medical Billing package

• Charge Entry – Accurate input of procedures, diagnoses, and modifiers.
• Database setup in our medical billing and practice management software to facilitate billing services.
• Clearinghouse setup, which includes setting up EDI and ERA
• Claim Submission – Preparing and submitting electronic and paper claims to payers.
• Payment Posting – Recording payments from insurance companies and patients.
• Denial Management – Identifying, correcting, and resubmitting denied claims
• Accounts Receivable (A/R) Follow-Up – Tracking outstanding claims and accelerating collections.
• Patient Statements & Billing – Generate patient statement.
• Reporting & Analytics – Monthly financial reports, performance analysis, and revenue insights.
• Compliance & Security – Ensuring HIPAA compliance and data protection.
• Practice Support – Ongoing consultation to optimize reimbursement and workflow.
• Identifying ways to streamline the billing process to increase efficiency and cash flow.

18. What is your process for handling denied claims?

• Identify & Analyze – We review the denial reason codes from the payer.
• Correct Errors – Address coding, documentation, or eligibility issues.
• Resubmit Claims – Corrected claims are promptly resubmitted for payment.
• Appeals (if needed) – When necessary, we file appeals with supporting documentation.
• Track & Follow-Up – Continuous monitoring until the claim is resolved and paid.
• Root Cause Prevention – We document patterns and implement process improvements to reduce future denials.

19. How do you ensure compliance with healthcare regulations (HIPAA, ICD-10, etc.)?

• HIPAA Compliance – All patient data is handled securely with strict confidentiality protocols, encrypted systems, and role-based access.
• ICD-10 & CPT Coding Accuracy – Our certified coders follow the latest coding standards and payer-specific guidelines.
• Regular Training – Staff undergo continuous training on HIPAA, ICD-10 updates, CPT changes, and compliance best practices.
• Quality Audits – We conduct routine internal audits to ensure accuracy, compliance, and error prevention.
• Secure Technology – Claims are processed through HIPAA-compliant software with audit trails and data protection safeguards.
• Ongoing Monitoring – We stay up to date with federal, state, and payer regulations to ensure full compliance.
• Feel free to schedule time on my calendar if you wish to discuss further.

20. What sets your medical billing service apart from other companies?

• Personalized Service – Unlike one-size-fits-all solutions, we tailor our billing strategies to meet the specific needs of each practice.
• End-to-End Revenue Cycle Management – From patient eligibility checks to claim submission, denial management, and reporting, we manage the full cycle.
• Technology-Driven Approach – Powered by advanced billing software and analytics, we maximize accuracy and speed while minimizing errors.
• Compliance & Transparency – We strictly adhere to HIPAA and healthcare regulations, providing full visibility through detailed reporting.
• Proven Results – Higher claim acceptance rates, faster reimbursements, and improved revenue recovery compared to industry averages.
• Dedicated Support – Our clients get a dedicated account manager and direct communication—no waiting on generic call centers.

21. Do you provide any kind of audit services or regular performance evaluations?

“Yes, we provide both audit services and regular performance evaluations”.

• Personalized Service – Unlike one-size-fits-all solutions, we tailor our billing strategies to meet the specific needs of each practice.
• End-to-End Revenue Cycle Management – From patient eligibility checks to claim submission, denial management, and reporting, we manage the full cycle.
• Technology-Driven Approach – Powered by advanced billing software and analytics, we maximize accuracy and speed while minimizing errors.
• Compliance & Transparency – We strictly adhere to HIPAA and healthcare regulations, providing full visibility through detailed reporting.
• Proven Results – Higher claim acceptance rates, faster reimbursements, and improved revenue recovery compared to industry averages.
• Dedicated Support – Our clients get a dedicated account manager and direct communication—no waiting on generic call centers.

22. How do you ensure accurate coding and reduce the chances of errors?

• Double Review Process – Claims undergo a multi-level review, with coders and quality assurance specialists checking for accuracy before submission.
• Technology Support – We use advanced billing and coding software with built-in error detection, coding edits, and compliance checks.
• Continuous Training – Coders receive regular training on payer updates, coding changes, and compliance requirements.
• Feedback Loop – Denials and rejections are analyzed to identify trends, and corrections are applied to prevent repeat errors.
• Collaboration with Providers – We work closely with physicians to ensure documentation supports the codes used, reducing compliance risks.