- How do we get our claims to you?
We can have them faxed, mailed (USP “Priority Mail”) or submitted to us electronically through a secure internet connection. We will provide to you the pre-labeled mail packs with postage affixed so that it is easy for your staff to get the claims and EOBs out the door to us three times per week. If you choose the electronic method, our software also includes a Scheduling component, which makes it very easy for you to print superbills, maintain patient demographics, and get the claims to us immediately on a daily basis. The monthly cost for this method is $50. With the continuous rise in postal rates, more of our clients are using this method. You can visit: www.medicalrepublic.com for more info.
- Do you transmit claims electronically?
Yes, to those companies that have the capabilities and that are efficient with EMC (Electronic Medical Claims). We do process certain payers on paper only because it has been our experience that those are actually paid faster. Remember, most insurances require that you are credentialed with them for us to be able to submit electronically on your behalf.
- How quickly do we get reimbursed?
The variance of payers and many outside factors make this a difficult question. However, the average turnaround in the industry is 30-45 days. Obviously, some are more and some are less. You may sometimes see different software or billing firms tout “you will get reimbursed in two weeks with our firm!” The fact is that CMMS/HCFA is required to hold the claim for 13 days for all electronic claims and 23 days for paper submissions. Even for commercial payers, 14 days is an exception and certainly not the rule. The National average for Days In AR (for Family Practice) is 43.
- Will you also be re-submitting for secondary insurance, tertiary?
Secondary resubmissions are included in our service. However, tertiary processing is not. The reason: usually one ends up processing a claim for $5.00 and by the time you hear from the tertiary company, the time frame is 6 months which is hardly worth it for the provider. We suggest having the patient pay and then get reimbursed from the tertiary.
5. What is your average collection rate?
First you should define “collection rate”. The “Net” definition is defined as: payments divided by gross charges, minus adjustments. Our average “Net” collection rate is 90% to 93% of your allowed amounts (based on payer contracted rates). The National Average for Primary Care providers is 92% for Net, and 65% Gross collections.
- How quickly can you be up and running?
1 day if necessary; however, we prefer 2 weeks to ensure the smoothest transition possible. (This is also dependent upon credentialing if you are a new practice which may take longer). We also like to start at the beginning of the month so that it is easier for you to separate your previous dates of service from the “cutover” dates to AMBS.
- How do we get our existing patient data to you?
There are 2 options: 1.) A complete printout (or softcopy) from your existing system. 2.) Provide to us the most current patient information as you see them. This also gives you the opportunity to “start fresh” with your data and have your patients re-register.
- Should we continue to work our previous billings/collections once you take over? If possible, we prefer that you continue to work (post payments and re-bill) your existing accounts receivable for a period of three months. If this is not possible, we can handle that as well.
- How do I know that you will be more effective than our own office staff?
First, one must define billing. We do more than process claims (see the Service Proposal). In short, our timeliness (claims processing), consistency (no leave, no vacation, no absenteeism of staff), accurateness (we do not send out claims that we are not completely confident will be paid), incentives and claim status will generally result in increased cash flow.
- What is your turnover rate for your staff?
Minimal. 80% of our staff has been with us for 3+ years. We have highly dedicated staff that also brings many years of experience. Because we take a team approach, (where most providers are unable to do internally) we are not impacted when one individual has to leave for vacation, illness or upward advancement in their career path with AMBS.
- How do I know that my patient data is secure?
We have a state of the art network in our operations center that backs up all client data several times per day with offsite storage for backups and redundancy. We also have a secured building with complete offsite alarm monitoring. Our staff all sign confidentiality agreements and we don’t give out information over the phone to anyone but patients, or responsible parties. Our contract addresses this.
- Will I have a dedicated resource to our account?
Yes. AMBS utilizes a “team” billing approach. Your account will be handled by a small team of no less than three to four reps that will all be cross trained on your account. This will allow for more than enough coverage as you grow your practice. Each team has 15+ years of experience.
13. How often are my claims processed?
Within 24 hours of receipt we will prepare your claims for processing. Obviously, if we need to gather additional information from your practice, we will reach out to you for that information, and prepare for processing upon completion of receipt of that information.
14. Where does my money go?
All payments come directly to your office. You then send us the EOBs along with your daily super bills / encounter forms. This way we can appropriately track and close the loop on all reimbursement activity. We scan all of the EOBs for electronic storage and for your future reference should you need them.
15. How much experience do you have with my medical specialty?
90% of billing is billing, no matter what the discipline. The 10% differences tend to be discipline specific nuances. We have experience and a current client base that is made up of everything from Family Medicine and Urgent Care, to Allergy/Asthma to Surgery, Psychiatry, Psychology, Podiatry, Physical & Occupational Therapy, Chiropractic, Home health, and Cardiology.
16. What type of software do you use?
We use proprietary software. We have found however, that over the years software packages are software packages, and they are only as good as the biller and the billing process.
17. I’m new in my practice – How do I set my fees and will you assist in watching reimbursements?
We advise most of our clients when setting fees initially, or re-setting your fees to work from the Medicare allowed fee structure and multiply by 130% or 1.3. We will continually monitor your reimbursement rates to make sure that you are maximizing your reimbursements with correct fees, and we will provide the appropriate advice when deemed necessary.
18. Why do some billing firms only charge by the claim vs. a percentage of collected revenue?
Many new billing companies will charge you a flat fee per claim because they are normally only skilled in the initial “transmission or submission” of the claim to the insurance company. Frankly, this is something you could do internally. Most tenured billing firms will charge you a percentage of what they collect. They are more compelled to work harder, follow through with secondary submissions, denials and work to get you the highest reimbursement possible – a “win-win” for both.
19. What is an acceptable AR (Accounts Receivable) amount?
We at AMBS have found over the years that an acceptable formula for determining your “AR Health” is to multiply your gross average monthly charges by 2.5 to 3. Example: Avg. monthly charges $40,000 x 2.5 = $100,000. If you are at or above this number, there is a chance that you will need to put a greater focus on your “growing AR”. This is something that AMBS has become an expert at doing. We also like to see your 120+ at 18% of the total or less – this is based on National Averages.
**Also note that your billing company has no control over a portion of your AR – and that is Patient Responsibility amounts. This is where you have to have tight internal collection controls and protocol on when to send accounts to collections.
20. What makes AMBS different from most other billing firms?
We have found over the years that we have three strengths that allow us to be competitive and provide us continual referrals from our clients:
a. Our approach - we take a consultative approach to your business. Since we come from the healthcare industry and have managed multiple clinics, we can walk in your shoes and understand and anticipate your challenges as a healthcare provider. Call it free consulting, call it what you want – we call it added value – value that we love to share with you.
b. Our experience – we have seen many small start-up billing firms come and go. Since 1989, we have developed many happy clients, who will attest to our consultative approach and work ethic to make your outsourced billing a success.
c. Our fees – We made a decision many years ago that by minimizing labor and realestate costs (AND Yes, we are still 100% based in the US - no offshore staff), and by providing exemplary quality and experience in billing, we could be one of the most competitively priced firms on the East Coast - supporting the entire U.S. No set up fees AND no annual contract,
