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Frequently Asked
Questions
We have compiled a list of
frequently asked questions to provide you with additional information
you may find helpful. Of course, if you have any additional
questions, we'd love to speak to you or meet with you one on one.
Please give us a call at 888.483.9893.
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here for STATco support.
General Questions
How many years have you been in business?
Health Claims Plus has been in
business for 11 years.
Do you have a compliance plan in
place?
Yes, Health Claims Plus has a
compliance plan in place that is reviewed and improved as needed on a
regular basis.
Do you have the necessary HIPAA
regulations in place?
Yes, Health Claims Plus is HIPAA
compliant.
Has your company ever been
investigated and found guilty in a fraud or abuse case? If yes, what was the
outcome?
No, Health Claims Plus has never
been investigated and found guilty in a fraud or abuse case. We pride ourselves on
honesty and integrity.
Have you provided billing services
for a company that has been found guilty in a fraud or abuse case?
If yes, what was the outcome?
No, Health Claims Plus has never
provided billing services for a company that has been found guilty in a
fraud or abuse case.
What type of training do you provide
your staff?
Health Claims Plus has its staff
regularly attend seminars, workshops, and in-house educational training.
How often is training done?
Training at Health Claims Plus is an on-going process.
Do you carry errors and omissions
insurance?
Yes, Health Claims Plus has a $1
million policy.
Billing Questions
What insurance companies do you bill
electronically?
Health
Claims Plus bills all major insurance companies electronically.
How is information transmitted back
and forth between the EMS service and billing service? Is the
information sent on paper, disk, or electronically?
Most information is transmitted
electronically or communicated over the telephone. Depending upon
the services rendered by HCP, paper runs may be sent via USPA priority
mail or electronically using pre-approved software.
How is the work load distributed?
Is one person responsible for an account, or do several people work on
it?
Several staff members and departments are involved with each account.
Each account is assigned a primary biller, a primary A/R clerk, a
primary appeals clerk, and additional ancillary staff for miscellaneous
duties.
Do you handle all billing-related
and ancillary documentation to insurance companies and private-pay
patients?
Yes, we do.
How often do you submit claims to
insurance companies?
We process claims daily depending on
information receipt.
How often do you send statements to
patients?
Statements are sent to patients on a
continuous cycle every 30 days.
Who is responsible for coding?
Our
Billing staff (with aid of HCP issued sign/symptom form completed by
medic) is responsible for coding.
What is the process/policy for
handling problems such as incomplete billing information?
A billing clerk emails a request to
the provider. If there is no response, the billing manager
contacts the provider via telephone. If there is still no
response, manager will return run report to provider with explanation.
How are electronic rejections
handled?
Rejected electronic submissions are
corrected and resubmitted immediately following receipt.
Payment posting/follow-up
Questions
How are returned claims and
statements handled, and who is responsible for them?
Returned claims are tracked for future education and processed by our
billing staff. Returned statements are researched and processed by
ancillary support staff.
Are payments posted line by line or
by the total amount of the claim?
Payments are posted by line item.
How are zero payments (deductibles)
posted?
Zero is posted for said carrier, if
there is no other insurance, then a statement sent to the patient.
How are denied claims posted and
tracked?
A note is posted for said carrier
and routed to appeals specialist. Appeals dept then “tags” claim
as appealed for further follow-up once appeal is performed.
How are rejections tracked and
resolved?
Ancillary staff performs a monthly review and analysis of rejections.
All rejections are resolved immediately as above.
How often are reports run for credit
balances?
Reports are run monthly.
How do you handle credit balances?
Credits are confirmed & formal
request is issued to provider.
Who reviews the reports and makes
the decisions regarding bad debt, write-offs, etc?
Our internal audit
specialist validates data and submits a report to providers for either
bad debt or collection agency approval.
Reports Questions
What types of standard reports do
you provide?
We
provide EOM Summary, Productivity both weekly and monthly, Service
Analysis, Patient Aging, and Insurance Aging. Others may be
available upon your request.
Can you provide customized reports?
Yes
(extra charge may apply).
Can an aged report be generated by
“billing date” and “date of service”?
Yes, an aged report be generated by
“billing date” and “date of service.”
Can one report be generated showing
a patient’s name, insurance provider, charge, payment, adjustment, and
balance per run?
Yes, we can do that for you.
Can you provide a report showing the
names, amounts and reasons for bad-debt write-offs and full adjustments?
Yes, we can.
Cost
Questions
How do you determine your fees?
Health Claims Plus uses a
percentage-base structure.
If payment is by percentage, is it
determined by the amount billed or by the amount collected?
We only charge based on a percentage of
the amount collected.
Is there an additional charge for
paper runs?
No.
Approximately how long will the
conversion process take?
New providers take up to 60 days
(due to completion of Carrier applications). An established
provider should only take up to 3 weeks.
Do you handle any old accounts
receivable from the previous billing company?
This function is outsourced to our Collection Agency.
Data Entry Questions
What types of forms and data is the
ambulance service required to submit to you?
We require a complete run report (trip
sheet) with complete narrative and demographics. A hospital face
sheet is also helpful, as are nursing home sheets. Copies of PCS
forms & patient signature sheets will also be needed.
From the time you receive the data,
how much time do you need to process the claim?
It typically takes 5 to 7 days for
us to process a claim.
Computer/Software Questions
What is the security system and who
has access?
Health Claims Plus is on a secure
network, monitored daily by software, hardware, and human personnel.
All software is password protected based on user access levels.
The Systems Administrator and CEO/President has full access to the
system and security delegation, and advanced permissions are given to
management. All other staff has very limited access to the system.
Do you have regularly scheduled
virus checks?
All workstations and servers are
monitored for virus activity in realtime. Virus software is
updated daily.
When is the system backed up and
where are the backups stored (onsite or offsite)?
The system is backed up on a daily
basis. All backups are stored offsite.
How would the system handle the
following situation? A patient changes insurance companies, and there
are outstanding balances on Plan A and new charges on Plan B.
Our system allows insurance per
claim (per run).
Can the system handle two primary
insurances and differentiate which needs to be billed by date of
service?
Yes,
it can.
Collection
Questions
Do you have a separate department
that handles collections?
Yes.
What is the collection procedure for
private-pay patients?
Our collection department contacts
the patient to confirm no insurance, then tries to work with the patient
on a payment plan.
If the ambulance service does not
provide the billing service with information in a timely manner, is the
account written off as a bad debt or as an insurance adjustment?
Neither.
How do you document services
provided but not billable due to timeliness?
Post zero payment, make notation on
account and transfer to a write-off report and submit to provider.
Is there a charge to document
services not billable to the insurance company or patient?
Yes.
What process is followed to turn an
account over to collections?
Accounts are identified by audit
specialist and submitted to Provider for approved adjustment.
If an account is turned over to a
collection agency, are the “regular rate” fees subtracted from the
amount due to you when payment is collected?
No, this service is outsourced & the collection agency fee is then
applicable.
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