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Frequently Asked Questions

 

The following is a Q&A list of issues that our clients frequently want to know:

 

  • Q: How long does it take to get our claims paid.

    • It depends whether you are on contract with the patient plan that you are billing. Contracted payer claims often have a quick turnaround in as little as 10-14 or days or less.

    • If you are not on contract with the plan, the claim is to be adjudicated within a 30 day period. Please note that this means processed but not necessarily paid. The work for your billing firm for these types of claims starts after this period. Often claims off contract are adjudicated incorrectly with published industry levels reaching 40%. A deep understanding of the out-of-network space is necessary for billing firms to be successful for their clients.

  • Q: How do we send and receive information, so that you and we are HIPAA compliant for billing purposes?

    • We subscribe to a HIPAA compliant document service that allows you to view all the claim information that F5 Surgical is processing. Most providers fax in their facesheets, and will receive a timely follow up email from our staff notifying them of proper receipt of the documents and what documents were received.

    • EOB information as well as other payer communications is also placed in the shared document folders which allow our clients to see real time how their claims are processing.

  • Q: What does your firm do when you are following up on a claim with problems?

    • Make calls, make calls, make calls. The healthcare industry is dominated by sophisticated payers and plans who continue to consolidate and improve their processes to increase revenues and profits. One method that is typically used is to initially deny or slow down payments for healthcare claims. The industry has learned over the years that most billing firms and small providers cannot afford the man hours necessary to work claims inaccurately processed the first time. Hold times on IVR systems can often range up to 45 minutes, callers are redirected to other service departments or calls are flat out dropped.

    • F5 Surgical uses the economy of our claim volume to reduce the burden of this inefficient process. Our staff, once in contact with the payer, works many, many claims with that payer representative so that the lag time involved in getting to the right person is reduced. This reduces our cost as well as the processing cost to our clients. Billing firms promise aggressive claim follow up, but when vetting a potential new billing vendor for your business, ask them exactly how they tackle this problem.

 

 

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