EOB has been doing our billing for quite a while now. Not only is their staff incredible to work with, their knowledge is exceptional. They able to provide us with so much insight regarding policy changes as well as always obtaining the highest level of care needed for our clients.
We needed a to billing company that knew what they were doing and knew the industry. A colleague suggested this company and we made the move. EOB made the move transparent and effortlessly, the staff know what they are doing and are very pleasant to work with. They know the industry and latest trends as well. At first I thought it was because we were a new company with them, however we've been with them for awhile now and they are still fast to respond to calls, or emails. Since making the move, we've noticed a decrease in denials, increase in reimbursement, faster reimbursements and more communication regarding any potential problems. They've been a great team member for us and my staff and I rely upon them for there expertise and knowledge.
We are a Sacramento -based substance-abuse facility, and over the years we have been through multiple billing companies. We have always had problems finding ethical and reliable billing services that will fight for our reimbursements to the very end. We have found that most billing companies will go after the “low hanging fruit“ and discard problem claims and appeals forcing us to write off those reimbursements. Since coming on board with efficient optimized Billing, we have been impressed with their willingness to fight insurance companies on those very problematic and technical appeal claims. We have seen an increase in our reimbursement as a result. The utilization review is amazing, they are very transparent and communicative throughout the whole process. Their claims team is just transparent, providing us weekly updates and reports. What’s also nice is they utilize a very transparent AR sheet, which we can check in real time to make sure that claims are being worked on and what the status of the claims are. It’s a completely different experience than any other billing company we have worked with in the past, and unfortunately we have had to go through quite a few. I would recommend EOB to anyone who feels like there billing company is not being 100% transparent, or giving you a full picture of where your account is. I can honestly say that for the first time we feel like our billing company has our best interest at heart.
We have enjoyed working with EOB over the past year. The level of professionalism, transparency, customer service and prompt communication assist our company in reaching our goals. We have worked with a handful of other billing companies and were always disappointed. With EOB we are 100% satisfied in the services they have provided!
ABOUT EFFICIENT OPTIMIZED BILLING (EOB)
EOB was created out of frustration and necessity. The frustration that such a critical part of your business relies on a service most healthcare owners know very little about and truthfully, do not care to learn about. The frustration that unless you’re a substantial “account,” you’ll probably be on the back burner and receive minimal effort from the larger sized corporate or outsourced billing providers.
The necessity that your revenue stream and cash flow is one of the most important aspects of keeping your business going. Are you worried that a smaller company won’t be as cutting edge, as knowledgeable, or have the sheer manpower to continually be chasing after your money like it's our own? Think again. And yes, your money is technically our money because you only pay on what you collect and deposit into your bank account. Your cash flow is our cash flow. Your livelihood is our livelihood.
VERIFICATION OF BENEFITS
CLAIMS FOLLOW UP
PATIENT COLLECTION COMPLIANCE
The collection and documentation of deductibles and coinsurance have never been more critical to your treatment center than it is now. On October 24, 2018, President Trumped signed H.R.6 - SUPPORT for Patients and Communities Act into law. The document is over 250 pages long, and while most of it may not apply to your treatment center or private practice, there is a specific section which makes waiving deductibles and coinsurance a federal felony with consequences of up to 10 years imprisonment and $200,000 in fines, per incident.
Here is the section that is most relevant:
shall be fined not more than $200,000, imprisoned not more than 10 years, or both, for each occurrence.
“(2) pays or offers any remuneration (including any kickback, bribe, or rebate) directly or indirectly, overtly or covertly, in cash or in kind—
“(5) a waiver or discount (as defined in section 1001.952(h)(5) of title 42, Code of Federal Regulations, or any successor regulation) of any coinsurance or copayment by a health care benefit program
Efficient Optimized Billing is now offering our patient collections compliance service to all treatment centers and providers that wish to stay in compliance with the law. Visit our Compliance page to learn more about these new changes in the law.
VERIFICATION OF BENEFITS
One of the most critical aspects of medical billing is the verification of benefits. The VOB is where you start the insurance billing process as you will need to know what the patient's financial responsibility is, if they have coverage for your services, and what to expect for reimbursements. Whether you are an in-network provider or an out-of-network provider, we will quickly handle this process for you and provide you with a detailed verification to help you make smarter front-end decisions before admitting a client. This is especially beneficial for out-of-network providers where there are no agreed to reimbursement amounts. Fortunately, we have years of data from billing for thousands of clients and can accurately determine what an insurance policy should pay you based upon this historical data. This is especially important for smaller facilities that rely on consistent cash flow to get them through the month. Our goal is to support you any way we can and give you accurate numbers on what to expect so you can plan your expenses and not have to worry about coming up short because you thought a policy was going to be reimbursed at 100% when in reality, historically it only pays 10% of the billed charges.
Feel free to run an unlimited number of verifications as we are an all-inclusive provider to you. We have zero interest in taking up precious time at the end of the month to invoice you for the amount of VOB’s we ran or any other task you asked for us to do. We are partners with you, and your success is our success. For us, it does not make sense to waste time and energy on pointless accounting when we could be collecting money for your business. EOB only charges a flat percentage of the funds you bring in the door. No hidden or additional fees whatsoever.
Utilization review is the process of receiving authorization for the services you wish to provide to your patients. While some lower levels of care (IOP & OP) do not require authorization to submit a bill for reimbursement, almost all higher levels of care (DTX, RTC, and PHP) do require authorization. This authorization is a commitment from the patients' insurance provider that they are deeming these requested services medically necessary. As long as the patient has an active policy and you are meeting the criteria for treatment at each level of care, you will be paid for your services.
EOB’s utilization review team should really be classified as patient advocates. As I’m sure you’ve experienced before, most insurance companies goal is to drop a patient down to a lower level of care as soon as possible. This is done to save money without much regard to the patients' health or needs. These practices have forced us to remove the utilization review process from facilities and handle it internally. Our patient advocates are expertly trained in medical necessity and the specific ways of presenting a case to an insurance care manager. Our goal for each review is to provide an overwhelming amount of evidence as to why a patient needs to remain at a certain level of care and receive extended services. An additional ten days at the residential level of care could be the difference between long-term sobriety and relapse for a patient, so we take the UR process very seriously. We do this by combing through your medical records to find any bit of information we can use to our advantage while ensuring medical necessity is being met so you do not have any issues should medical records be requested.
Another advantage is that our utilization review team has over 30 years of experience and have built quite the rapport with care managers at insurance companies. We have established a reputation for being honest, fair, and ethical which grants us less scrutiny when asking for authorizations. Insurance care managers know that we are excellent at we do and although it may seem a little unfair, wouldn’t you prefer to have someone who is on a first name basis with a care manager requesting authorization for your facility than someone who has never spoken to them before? Should our request for authorization be denied or require an urgent appeal, we have an in-house psychiatrist that specializes in utilization review. Our UR team is a direct extension of your treatment team and will quickly become your clinicians best friends. We focus on simplifying the process and maximizing the number of days a patient can stay in treatment so that you can focus on what you’re passionate about, treating your patients.
PEER TO PEER
If you have your in-house doctor conducting your peer to peer reviews, you are leaving large amounts of money on the table. Not only are you taking time away from your patients, but you are also asking too much of your doctor and negatively affecting their attitude when they don’t understand why they lost a peer to peer review. Your doctor is there to provide the highest level of care possible to your patients, not to negotiate with insurance companies who do not play by the same set of rules. No matter how honest and compelling their argument may be, the fact is that insurance companies love peer to peer reviews because it is their most significant opportunity to deny your claims and not pay for numerous days of service you've already provided. The unfortunate reality is most doctors are incredibly passionate about the care they are offering and go into peer to peer reviews with a very high level of confidence because they believe in the work they are doing (and trust us, we believe in it too!). The problem is you literally have someone at the insurance company who is only looking for reasons to deny their request.
It's really a losing battle to begin with as you have to present a 100% perfect case to the insurance company. Even if you misspeak on one minor factor, it almost always results in an instant denial of all days requested. It’s the equivalent of being represented by a public defender in a severe court case when you actually need a specialized attorney. What you want is an experienced doctor that exclusively does peer to peer reviews. Our peer to peer review doctor used to work for insurance companies and is familiar with all the ins and outs of their requirements and games they play. They also have over ten years of experience in the utilization review field specifically, which means they've been speaking to the same people at insurance companies for some time now and have built solid relationships. Ask yourself honestly, would you rather have your own doctor who has no established relationship conduct your peer to peer review, or our doctor who has had a working relationship and friendship with these insurance companies for over a decade? It makes a huge difference. The best part? It's included in our package to you. No hidden or additional fees whatsoever, regardless of how many peer to peer reviews we win for you each month.
THE EOB DIFFERENCE
When billing for a treatment center or private practice, we have found that processing your dates of service on a daily basis is the best practice for receiving quick reimbursements. Rather than let billing stack up for days or weeks and sending out high dollar claims to the insurance carrier, we believe it’s far more effective to fly under the radar and bill low dollar amounts. In our experience, bills over $10,000 have a higher risk of being sent for review and ultimately delaying the processing of your claim, or worse, triggering a medical records request.
By following this procedure, we also find out very quickly if there are any issues with a policy, such as a retro termination of benefits which is especially common for substance abuse facilities as their patients are usually not on the best terms with their employers. We also have numerous built-in checks and balances to ensure you never miss a day of billing. We are human after all, but with multiple sets of eyes on your billing, you can have confidence all your dates of service will be processed promptly.
EOB can provide a billing service for any healthcare professional that accepts insurance, so even if you are not a treatment center, please do not hesitate to contact us with your needs! We currently bill for substance abuse facilities, mental health facilities, chiropractors, psychiatrists, large physician groups, wellness centers, and medical management companies.
Now that you’ve verified your patients' benefits, have received authorization to provide the requested services, and have billed for the services rendered, it’s time to follow up with the insurance company to ensure they pay your claims promptly. There are a lot of different ways to do claims follow up, and most often we find that people take the easy way out. You’ll often find billing services or software touting high pass through and acceptance rates for their claims which seems silly to us. It is not difficult to get an insurance carrier to receive your claim, but it can be very challenging to get them to pay you a fair rate that you deserve. Claims follow up is our largest staffed department at EOB as it takes a staggering amount of manpower to follow up on a facilities claims properly. You can submit a claim, sit back, and wait to see what happens and make corrections as requested, but we do not feel that is the proper way to manage a facilities revenue.
Your cash flow is essential and the longer you push out receiving reimbursements for a claim, the higher chance you have of losing out on that revenue. If there are indeed problems with your claim submission, the insurance company is definitely not in a hurry to tell you about it as their goal is not to pay your claims. For this reason, we bill for your dates of service on a daily basis and follow up with the insurance carrier within three business days to ensure they have received our claim and are processing it without issue. By doing this, we catch any problems very early on and also have a rapid turnaround time for payments being made. Our standard at EOB is to have your claims paid within 2-3 weeks from their date of service.
Rather than sit back and pluck the low hanging fruit, we are continually fighting low payments which are becoming increasingly common with out of network claims. Fortunately, there are many tactics that you can employ to battle these underpayments! It would be much easier to accept what the insurance company initially offers, however, we have a specific negotiation and sales training program for our claims follow up representatives to ensure you have someone well equipped to negotiate higher payments for your facility. Our claims follow up team are not robots reading off of a script! They are continually adapting and finding ways to increase your reimbursements for each claim we submit.
If for some reason our claims follow up team is not able to get a reimbursement we believe is fair, your claims will be forwarded to our internal low payment department where it will reprocess by a completely different team that exclusively handles low payment claims. There are multiple efforts made by our team to get your claims paid at a fair rate. If you feel that your reimbursements have been lacking or even dropping over the years, your billing company has probably not dedicated the resources to developing a low payment department. We have tried to assign low payment appeals to our traditional claims follow up reps, and the difference in results is drastic with a dedicated department. You will absolutely see higher reimbursement rates.
One of the biggest threats to every treatment center is medical records. Insurance companies are always looking for ways to deny claims, and their most effective way of doing this is by requesting medical records for a patient. You would think a high amount of important would be placed on keeping good medical records, but unfortunately, we have yet to come across a facility that initially has had zero issues. Whether it be missing a group note, not signing off on therapy sessions, a patient is not programming for their required number of hours per day or a patient not meeting medical necessity; these are all things that will have your claims denied instantly.
To make matters even worse, you only have a set amount of time to respond to a medical records request and the process of sending them in can be quite the daunting task. You must print out the patient's entire chart, go through and neatly organize it, ensure everything is complete and accurate, then physically mail it out via trackable delivery to confirm the insurance carrier receives it. Depending upon the number of days requested, this could be multiple hours out of the day for someone to complete a request for one patient. We have found that it’s human nature to push off larger tasks like this and have consistently found medical records not sent past their allotted time frame when auditing a facilities utilization review, billing, and collections. This results in full denial of all claims with no recourse to try and fight for that lost revenue. For example, if you have 30 days of a patient stay that has been requested, at $2,000 daily average for reimbursement that could be a $60,000 mistake!
For this reason, we have an entire medical records department at EOB that solely focuses on managing and completing medical record requests. Depending upon your facility size, we may even assign multiple specialists to only work on medical record requests for your facility.
We take this process so seriously not only for revenue purposes but also because it’s something that can raise red flags with an insurance company and potentially trigger an audit if you consistently do not send them in. If you are relying on someone on your staff that already has other duties in addition to medical record requests, there is a high probability you have lost billable days to do medical records. It indeed is a full-time job. Allow us to take this burden off of your plate and save you from making costly mistakes.
RISK MANAGEMENT AND ADAPTING TO CONSTANT CHANGES
It seems like every year some new changes are happening in the billing world that directly impacts your reimbursements and cash flow. Whether it be United Healthcare or Blue Cross/Blue Shield slashing their reimbursements by 40-90% before massive class action lawsuits are filed against them, Health Net flat-out declining all payments to providers, or even the increase in fraudulent policies you saw when Obamacare was implemented, we have always been ahead of these issues. Imagine having a great census or consistent patient flow and expecting to have a great month financially, only to be blindsided by these inevitable changes in the out of network billing arena. Seems unnecessary right? We think so too.
With over 20 years of combined experience in this industry, we have seen it all and have established enough connections with insurance companies and medical professionals alike to know when these changes are coming down the pipeline. We feel a substantial responsibility always to be looking ahead for our clients to ensure you do not wind up in the middle of one of these situations. We have seen far too many facilities close their doors due to poor communication from their billing company. It’s not a comfortable conversation to have, but wouldn’t you rather have your expectations set before you start amassing a large number of outstanding claims only to be told you won’t be receiving anywhere near what you expected in the 11th hour? It’s much easier to adjust your business model to adapt to the games insurance companies play when you’re ahead of the curve with some money in the bank, instead of when you’ve depleted your financial reserves after your billing company kept promising you it will get better. Let us be your eyes and ears and advise you on which carriers you can maximize your return on.
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Costa Mesa, CA 92626