Frequently Asked Questions
No, we sometimes have to verify correct diagnosis codes with the office, but we generally have no trouble getting things paid that are supposed to be payable by insurance.
The only problem we have is when offices use incorrect DX OR try and perform RFC before the 61 day mark allowed by Medicare.
We put the claim on hold and verify with the office if they meant to send X DX which we know will pay, or do they want us to submit it so that it will process to patient responsibility.
We have insurance aging employees who call on claims all day long. They touch each claim that is over 30 days old every month until it is paid. They become very familiar with the account and the insurance companies because they deal with them monthly.
Most definitely, it helps keep your cash flow consistent.
Good notes from the office to back up. We have a very experienced biller here, who came from a DME only billing company prior to coming to SMB. She has over 17 years in DME billing experience. So we have very few issues.
Check to make sure we have the proper modifiers. We make a call to see if they overlooked the modifier, or if we need to appeal with notes. Calling is key, talking to a human and getting to the bottom of the denial & how to fix.
Superbilll with clear valid DX and CPT, units, location modifiers, demo sheet, copy of insurance card, auth/referrals. Good communication should we be missing anything. Someone to send us any items needed quickly. (Operative report, referrals etc.)
They each have their own quirks. Luckily, we have experience with ALL insurance companies and their individual requirements. Therefore, we do not have difficulties; we have problem solvers here.
We have a fully staffed customer service department with employees who are very knowledgeable in handling all types of incoming issues/problems or concerns. We have a Collections Agency we recommend, or the client can use their own. We send three statements. If the patient makes no effort to pay anything or call to set up a payment plan after that, we put them on a list for you to approve before they are sent to Collections.
Yes, we are fully up to speed on billing all aspects of your practice.
Yes, we have 3 people who concentrate on vacation coverage and they are cross trained in all areas to be able to step in seamlessly.
Yes, we will update you with any changes in the LCD that pertain to your area, as well as make suggestions as to what you might want to bill that has been successful for your peers.