The Problem: Insurance Companies Hate To Pay What They Owe

As many doctors know, the whole process of filing insurance claims is cumbersome, time consuming and energy-draining. The insurance companies have made it as difficult as possible to get paid. Obviously they have a vested interest in paying out as little money as they possibly can. One of the best ways they hang on to their money a little longer is by creating an extremely difficult set of hoops that doctors have to jump through to file and collect their insurance claims.

This arduous process is probably all too familiar to you already. First, one must spend an average of 10 to 15 minutes filling out the CMS 1500’s.

This could take hours a day if one has numerous patients. If there are any minute details on the paperwork that are not filled out correctly, the insurance company rejects the entire claim and sends it back to you—unpaid. Then one has to figure out what the problem is, attempt to fix it, and then re-submit the claim and hope it is right the second time around.

The results of this frustrating process are startling: On average 32% of all claims are rejected, 5 to 15% are lost in the shuffle and never collected, and the average time it takes the doctors to collect their money is 60 to 90 days. It can be even longer for Medicaid claims.

In addition, aside from stretching the time it takes to receive payment, this process also presents one with another major problem: it takes a tremendous amount of employee and overhead cost for one to manage the entire claims filing process. In fact, the New England Journal of Medicine states that a typical doctor's overhead and billing expenses account for 43.7% of his/her gross income. This translates into an average of about one and a half clerical workers per doctor at an average annual cost of $51,564. This does not include the hidden costs like vacation time, insurance, and the like.

The Solution: Electronic Medical Claims Filing

Electronic medical claims filing now comes into play. Instead of relying on staff to laboriously file claims and then endlessly follow-up on them through the approval and collection process, now a physician can outsource the entire process to a medical billing professional. Fortson's Professional Services, LLC can also lower the time it takes to receive payment from an industry average of 90 days to as little as 7 days. We are trained professionals who are equipped with proprietary, state-of-the-art software that allows us to electronically file claims for you. The benefits to your practice are enormous.

Eliminate Software Hassles

We all know that the Internet has changed our world. Our Practice Management System is automatically upgraded on a daily basis and requires no complex installations. You have access to your client's data 24 hours a day, 7 days a week via the Internet.

Benefit #1: Speeds Up the Payment Process

Next Generation Electronic filing drastically reduces the amount of time it takes to collect payments from the insurance companies from 60 to 90 days to just 7 to 21 days. This is possible because electronically filed claims are handled by computers instead of human "gate keepers" at the insurance companies . These "gate keepers" are the ones who ultimately determine whether or not one should be paid. However, when claims are handled by computers there are no people to bog down the process.

Benefit #2: Lower Claims Rejection Rates

The rejection rate for claims utilizing our service can plummet from over 30% to under 2%. Obviously, claims that are not rejected move through the system more quickly. In addition, claims that are mysteriously "LOST" by the insurance companies and never paid are eliminated altogether. Claims cannot be lost when using electronic medical claims filing because they produce an acceptance report from the carrier that ensures receipt.

Benefit #3: Frees Your Time

This benefit is not always quite so obvious to doctors, but is very significant nevertheless: doctors spend as much as one and a half to two hours a day supervising and working on insurance claims. At the very least, physicians have a high-paid staff person working on filing the claims. Our system can give you more time to either see more patients, and therefore make more money, or spend more time doing what you want to do. This also frees up the time of your staff members, allowing them to make more patient calls and run the office more efficiently.

Benefit #4: Immediate Cost Savings

An office can realize an immediate cost savings when outsourcing it's billing to us. A recent survey in the Medical Group Management Journal showed that the average cost of internal billing departments was 11% of the practices' income. Our billing services, on the other hand, charge much less to perform the same service, depending on the volume and complexity of the situation.

Frequently Asked Questions

Will my claims really get paid faster?
Most definitely. Electronic claims are always processed before paper claims, and because of the electronic tracking methods in place, the insurance companies cannot claim they never received your claims. With our exclusive next generation technology your claims can settle with money in your account in as little as 7 days!

How fast will I know if the claims have been accepted?
You will know that the insurance companies have accepted your claims within 24 hours. You can also check the status of your claims in real-time 24 / 7 on the Internet.

Will I be able to know at all times what claims have been filed?
You will be given a detailed verification report that will show what claims have been transmitted and when.

Will I have to have expensive equipment and software?
No. In fact, you do not have to have any equipment or software at all. With our specialized system your office can outsource all of your data entry of new patients, posting of charges and payments, and statements.

If you prefer not to outsource, then you can certainly keep your current software and equipment. Your billing specialist will only need a copy of the superbill and patient registration form to perform the billing. The services are completely tailored to meet your individual needs.

Will my patient charts ever have to leave my office?
Absolutely not! If there is any information your billing specialist needs, they would contact your office manager and request it by either fax or phone. Only information that is pertinent to filing the claim is necessary. All patient information is kept in the strictest of confidence and is only used for billing purposes.

So what exactly does the billing specialist need from our office to file the claims electronically?
We will need a copy of the super bill for services performed, a copy of the patient registration form, and a copy of the insurance card front and back. If Fortson's Professional Services, LLC is going to perform full accounting of payments as well, then we will need a copy of the EOB so we can properly post payments.

How will the information needed to file a claim get from my office to my billing specialist?
Because each office's needs vary, our billing specialists can work with you on an arranged time to pick up the necessary data to file the claims.

I do not have a formal superbill. Can one be designed for my needs?
Yes. Fortson's Professional Services, LLC can even put the form on two part NCR paper so your office will not have to make copies of them. The same can be done for a patient registration form.

What happens if the claim is rejected or paid incorrectly?
Your billing specialist will challenge any and all rejections and will do prompt follow up on any problems.

What are the liabilities involved in using an outside service?
At Fortson's Professional Services, LLC we take every precaution to ensure the quality and security of handling your billing needs. Our software and systems meet or exceed all the guidelines stipulated in HIPAA. All data is backed up on a daily basis and is stored off site in multiple remote data centers; a backup can also be provided to your office upon request. These data centers use the latest in security and hacker prevention to keep your data completely safe.

What would my office staff be responsible for?
Your office staff will be able to continually concentrate on increasing patient care and follow up on the status of all the patients who come through your practice. With this kind of care, your patients will become great word of mouth referral sources for you.