Please review some of our most commonly asked questions and for any further information, please CONTACT US today!
We are a medical billing service company located in Holly Springs, NC that specializes in claims submission, credentialing, and full-service billing. We can perform billing services for providers of any specialty within any state.
We have been involved in the healthcare industry for almost 20 years, and we have established an affordable business model that caters to the specific needs of small to mid-sized practices.
We are one of the few billing service companies that come from an IT background centered around HIPAA implementations, where our experience in programming and EDI provides us with a unique knowledge base for fulfilling the billing needs of our providers. As the healthcare industry increases its reliance on technology, our unique background allows us to standout from our competitors. We understand all of the different billing and technical issues that most providers encounter, and our experience allows us to solve these problems in a timely fashion to prevent any delays in reimbursement.
Additionally, we are fully aware that many healthcare providers are on tight budgets, and there is a limit to how many services they can actually outsource to a medical billing company. We also know that most providers do not have the internal resources necessary to dedicate to an ever-changing and more complicated insurance industry. Due to these factors, we have established a business model that can be customized to the specific needs of each provider; and will increase a provider’s cash flow, and reduce their billing issues, at an affordable and manageable cost.
HIPAA stands for Health Insurance Portability and Accountability Act. It is a law that was passed by Congress in 1996 mandating the rules that all entities involved in the healthcare industry must follow in order to do business. There are many provisions under the HIPAA law, such as establishing the universal standards for transmitting healthcare data electronically, as well as addressing the security and privacy concerns for protecting patient health information (PHI). All healthcare entities must conform to the HIPAA guidelines. Any violation of the HIPAA privacy and security provisions could result in stiff penalties, and in some cases, jail time. The main purpose of HIPAA is to streamline the healthcare process to eliminate billions of dollars a year that is wasted on administrative costs.
EDI stands for Electronic Data Interchange and it is used to represent the electronic formats of standard business documents. Under the Administrative Simplification portion of the HIPAA law, the EDI format was chosen to represent how healthcare information was to be transmitted electronically.
The EDI format that represents a Professional healthcare claim (HCFA) is referred to as an 837P transaction. The EDI format that represents an Institutional healthcare claim (UB) is referred to as an 837I transaction.
Due to the adoption of this standard, all healthcare entities are now able to program their systems based on the same universal formats, which streamlines the claim adjudication process and saves billions of dollars a year in administrative costs. All billing software, clearinghouses, payers, and third-party administrators transmit their data as EDI transactions.
A clearinghouse is a centralized hub through which providers can submit their claims and have them routed to the appropriate payer. Each payer who receives electronic claims is assigned a specific Payer ID# that will determine where submitted claims will be sent. (You can think of the Payer ID# as an electronic address for each insurance company.) If a payer does not receive electronic claims, then the clearinghouse will print the claim on paper and have it mailed.
Using a clearinghouse allows providers to have one method for submitting their claims. Providers will no longer have to deal with the labor-intensive task of printing and mailing in claims or having to log into multiple payer portals (websites) and manually enter in their billing data.
Any provider interested in using our services would need to fill out a Client Registration Form that we would send through fax or email. This form captures the information that we need in order to register a provider with the clearinghouse, such as Service and Billing Addresses, Specialty, TIN or SSN, NPI (Type1 and Type 2), etc. Please contact us if you are interested and we can send you this form.
No, but we do offer a contract in case you would like to sign one. We do not keep our providers locked into our services for any length of time. A provider who utilizes our services can leave any time they wish.
No. The first time we charge a provider for our services will be after their first month of claims submission.
For our claims submission only service providers will be billed a low monthly flat fee that never changes regardless of how much their claim volume increases. A provider could double the amount of claims they submit each month, and their monthly fee would still remain the same.
For our full-service billing option providers will be billed monthly based on a percentage of all insurance payments reconciled for that month. We only bill based on what insurance pays the providers. We do not charge for what is billed to the patient (i.e., deductibles, coinsurance, copays).
For our credentialing service, our fees will vary based on how many providers need to be credentialed and how many applications are involved for that particular payer.
Great question! We can only work with practices who are using a cloud based EHR software package that we can access remotely. We are proficient in using many cloud-based practice management systems such PIMSY, NueMD, Office Ally, etc. However, all EHR software packages have the same functionality. They just have different interfaces that make them look unique, but they all do the same thing.
So, if you have already purchased a cloud based EHR package and you wish to outsource your billing to a 3rd-party company like Regal Billing, just reach out to us and we would only need a couple of days to figure out how to submit and reconcile claims using your software.
It will only take a couple of days to get a provider setup for electronic claims submission to a commercial payer (such as Aetna, Cigna, UBH, etc.). However, depending on the state where the provider renders services, there are certain payers, like Medicare, Medicaid, or BCBS, that require separate EDI applications to be filled out before we can start submitting claims to those payers. It usually takes 2-3 weeks for those applications to process.
Yes. We can submit claims for both individual providers and clinics\facilities.
Yes. We submit to any payer that accepts a HCFA or UB claim.
We will register a provider with our clearinghouse and submit their claims using an automated process that will retrieve, transmit and archive their billing data file. We follow all HIPPA privacy and security guidelines protecting patient health information (PHI), and all transmissions will be submitted over a secure server.
Due to our extensive technical background, we are always looking for ways to use new technologies that will allow us to provide our services in an efficient and effective manner. Thus, we utilize certain web-based tools that will create a shared folder on each provider’s individual computer. Within this folder we will post a template file (similar to excel) that each provider would use to enter in their billing data. When ready to submit, a provider will save their billing information to their shared folder, and an automated process will retrieve their claim data and submit it directly to the clearinghouse.
A provider can post their billing data however often they want based on their own convenience. They can post daily, weekly, semi-monthly, or once a month. However, we would suggest they post at the end of each week so they can get paid more quickly.
If you utilize our claims submission only service, then your claims will be submitted to the clearinghouse the next morning after you post your billing file.
If you utilize our full-service billing option, then we will log into your EHR software at the end of each day and see if any claims have been released for us to submit.
If you utilize our claims submission only service, then an email notification will be sent to you once your billing has been retrieved and uploaded to the clearinghouse.
If you utilize our full-service billing option, then any notifications will be dependent on the cloud based EHR package that you have chosen to use for your practice.
No. We do not have any claim payments or EOBs mailed directly to us. All we do is submit a provider’s claims and any correspondence will still go directly to them.
Yes. We can submit claims for providers in any state. The billing service and provider DO NOT have to reside within the same state.
The short answer is “Yes”. We are able to submit claims for other specialties such as chiropractors, physical therapists, podiatrists, dieticians, etc. However, most of our clients are from the mental health field so we purposefully cater to that market, but we can work with other specialties as well. So please feel free to contact us to find out more information.
Yes! If you refer any providers towards our business and they end up signing up for our services, we do offer a referral bonus that will vary depending on which of our services they utilize.