What is the difference between a denied claim and a rejected claim?

A denied claim refers to a claim that has been processed and the payer has found it to be not payable and must be appealed for reconsideration. A rejected claim refers to a claim that has not been received by the payers due to invalid or missing information provided, (i.e.: name and identification number do not match, invalid procedure and or diagnosis codes.) It can be resubmitted electronically immediately with correct information.

Because paper claims do not catch this information, the claims must first reach the payers and be denied, and then resubmitted with corrected information. This can take up to 3 weeks before it reaches the provider, whereas with electronically submitted claims, errors are caught before the claim reaches the payers.

Will you also bill my patients, and can they contact you for any billing issues?

Yes, patient statements will be generated on a regular basis to inform the patients of activity on their accounts. Patient statements will clearly indicate when a patient balance is due. Should it be necessary, we will contact the patients by a series of letters and phone calls regarding any delinquent balances. We will contact your office and make recommendations for possible outside collections activity, if necessary. We will work closely with your office to be sure that your patients’ accounts are handled in a manner that meets your approval. Yes, the patients can contact us directly for any billing issues.

How can you be sure that you don’t miss a claim?

If you use free scheduling software, we are able to synchronize between our billing systems to ensure all claims are billed correctly.

How are payments received and where do the payments go?

All of your funds and deposits will still be in your control. Client must provide written notification in a timely manner of all collections they receive, including but not limited to patient cash payments, patient checks, payer checks and deposit of EFT (Electronic Fund Transfers) to BAYS RVP Billing & Consulting Inc.

Our recommendation is to set up as many payers with EFT (Electronic Fund Transfer) payments as possible. The EFT payments will go directly into the client’s bank account and the corresponding ERA (Electronic Remittance Advice) with the EOB (Explanation of Benefits) information available through the clearing house. For payers who do not use EFT payments, checks will come in the mail to the client for deposit. The checks and corresponding EOBs will need to be scanned and provide to BAYS RVP Billing & Consulting for posting via secure VPN or FTP. We want to have as many claims as possible sent electronically and we set up as many payers as possible to receive your payments via EFT.

How fast do you submit a claim?

We provide less than 24-hour turnaround from the receipt of data to claims submission for large and small accounts.

Do you process EOBs electronically?

Yes, BAYS RVP Billing & Consulting Inc. has the ability to process EOBs electronically, which is referred to as ERA (Electronic Remittance Advise), from Medicare and other insurance companies thru our clearing house. It is our preference to process EOBs electronically whenever possible to reduce payment posting errors.

How can you improve my cash flow?

Maintaining steady cash flow for a medical practice depends upon quick and timely payments from insurance companies. We transmit claims electronically to all insurance companies that accept claims electronically, which means you receive payments in 2-3 weeks, as opposed to 2-3 months using the traditional paper method.

We submit clean claims using our scrubbing software that catches coding and data entry errors before the claims are submitted to the insurance companies, which reduces rejections and ensures a faster collection cycle. We also follow up and challenge all denied/unpaid/partially paid claims until you are paid.

Are you HIPAA compliant?

Yes, BAYS RVP Billing & Consulting Inc. complies with all HIPAA privacy and security regulations.

HIPPA Compliance for BAYS RVP Billing & Consulting Inc. is committed to conducting business in compliance with HIPAA (Health Insurance Portability and Accountability Act) of 1996.

Privacy standards have been set up by the Department of Health and Human Services in order to ensure the protection of a patient’s health information from unauthorized disclosure. The Final Privacy Rule requires covered entities that transmit any health information in an electronic format to maintain the confidentiality of all personal identifiable information (PII).

We conduct comprehensive compliance reviews in order to monitor and audit HIPAA rules. At BAYS RVP Billing & Consulting Inc., we are proud to maintain HIPAA compliance throughout our medical billing services.

What are the fees for your services?

BAYS RVP Billing & Consulting provides our services based on a percentage of the revenue collected. This includes both insurance and patient payments. This method ensures that the goal of both of our companies is the same – to obtain the full financial reimbursement for services provided. We do not get paid unless you get paid!

Our fee includes our staff to assist you and your staff with any questions you, your practice or your patients may have about your claims and billing. Our billing system includes a database that is set up specifically for your practice and all of your claims, billing and coding processes.

We do not charge extra for re-bills, monthly reports, and monthly patient statements and denied claims. We charge one fee that includes all of our standard services; there are no hidden fees and charges involved.

Why is outsourcing my medical billing to BAYS RVP Billing & Consulting better than hiring a medical biller?

The primary reason for letting us handle your billing instead of doing it in- house is that it makes good business sense. As a business, you need to constantly generate revenue by getting paid for your services, and saving money by cutting overhead costs not having to worry about hiring a full time medical biller and paying for employee benefits. Our experienced staff ensures that your claims are submitted quickly and correctly, which means that you receive full and consistent payments. We can also work with your billing and EMR system if applicable.