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FAQ’s

How do you charge for your services?

We charge on a % basis of total revenue collected. If we don’t collect, we don’t get paid and we work hard to get paid.

I’m not located in California, can you still do my billing?

Yes! Currently we provide billing and provider enrollment services for customers in multiple states. Unless there is a state law in your state requiring that your billing service be in-state, we can do your billing. (PLEASE NOTE: We regret that we cannot offer services to professionals in Arizona, Oregon, or Washington State due to state requirements that billing services also be licensed collection agencies.)

How does it work?

It’s simple. You send us patient information and we verify benefits. You can fill out a day sheet daily or weekly and we bill charges. When you receive payments, you fax or mail the accompanying Explanation of Benefits (EOB) form to us.  OPTIMAL RCMS will take care of the rest!

(We offer multiple solutions to simplify and streamline the revenue cycle management process.  Keeping it simple and leveraging existing technologies and solutions is our goal.  If you are paper based, we can also work with that.  We offer full service or partial solutions and are flexible to accommodate the way you so business.)

How much does it cost?

Please click here and submit our NEW client questionnaire so that we may access your practice needs and determine rates.

Do you specialize in mental health?

We support several substance abuse treatment facilities, as well as MD’s, DC’s, PT’s and LP’s.

I don’t participate with insurance or managed care companies but patients want me to submit claims. Can you do that for me?

Our services can be used regardless of your network status with insurance companies.

Can you do patient statements?

Yes, statements are an integral part of our services. If necessary, we can also send statements to patients’ attorney or whoever is the guarantor for the account.

I lose money on sessions not being authorized or because patients use more than their yearly maximums. Do you keep track of authorizations?

We will maintain authorizations until the member is discharged.

Are you able to check benefits ahead of time so that I know how much to charge my patient when s/he comes in for the first time?

…within a prompt turn-around time. Simply forward us a copy of the front and back of the insurance card, patient name and date of birth.

How do I tell you when claims are paid?

If your practice is set up for EFT payments, we’ll usually know before you do. If you are still receiving paper checks, fax or email the EOB’s to our office for prompt posting.

Do I retain control over my money?

Absolutely. Patient and insurance checks are payable to you and received at your address, just as they are now. If you elect to have the payments sent to a secure drop box, we will provide you with detailed reporting of the revenue received.

I am not able to keep track of which claims aren’t paid, and then I lose money because things aren’t submitted “Timely.” Will I have to keep track of which claims are paid, or do you do that?

Weekly, we generate a 30+ Day Insurance Aging Report that identifies outstanding claims and we work this list in its entirety.

How often do you bill to insurance?

Frequent billing ensures a steady cash flow for you and we recommend billing daily wherever possible.

What is the expertise of your staff?

Visit our About Us section.

Will I have someone personally overseeing my billing?

Yes, Optimal RCMS realizes the importance of dedicated staff and we do our part to ensure you receive personalized attention.

Can you process patient credit card payments?

Yes. We partner with a healthcare merchant company to offer this service. Patients can either call our office with their credit card numbers or fill out a form at your office. They can also go to a secure site online to pay. There’s never any equipment to buy or rent. Note: there are additional costs involved to accept credit cards.)

Do you bill electronically?

Yes we partner with a clearinghouse to assist us with EDI transactions.

Are you HIPAA compliant?

Yes!. We are considered a “business associate” and when you sign up for the service, you receive a “business associate” contract to add to your HIPAA compliance plan.

What is a National Provider Identifier (NPI)?

An NPI is a unique, ten-digit, intelligence-free, numeric identifier. Intelligence-free means that the numbers do not carry information about health care providers, such as the state in which they practice, their provider type, or their specialization.

NPIs replace health care provider identifiers used for standard transactions under the Health Insurance Portability and Accountability Act (HIPAA). Those numbers included payer-specific IDs and Medicare legacy IDs (e.g., UPIN, OSCAR, PIN, and National Supplier Clearinghouse).

A provider’s NPI will not change. It will remain with the provider regardless of job or location change(s).

We currently do not bill electronically in the office; do I need to to have Optimal take over billing?’

No, Optimal will handle all your EDI needs with our practice management software. We’ll get you set up with EFT for quicker payments if you’d prefer also.

Can you get my NPI for me?

Yes

Can you register my NPI with insurance companies?

Yes

Are you submitting NPI compliant claims?

100% of our claims are submitted in compliant formats mandated by law.


Other Services


Can you bill for SAP evaluations?

Yes

Do you bill for specialized services?

Yes, many of our providers perform specialized services and we bill for them.

Can you bill Workers Compensation?

Yes

Can you bill patients’ Health Savings Accounts?

Yes

Can you extend authorization end dates?

Yes, many of our clients elect to outsource to Optimal their Authorization processes.

I would like to negotiate with insurance to try to get better rates. Can you help me with this?

Yes. Some companies are more willing to negotiate than others, and success frequently depends on criteria outside our control, i.e. network needs, your location, your specialties, company policy, and so forth. This service requires additional consultation and collection of data.

I am so tired of filling out credentialing & re-credentialing applications! Can you do this for me?

Absolutely, we partner with a National Provider Enrollment Company that offers exclusive rates to OPTIMAL RCMS and our customers.

Can you help me find managed care panels to apply to?

Yes. This is a separate service from our billing package. We have extensive experience in partnering with clinicians to discover the right blend of managed care participation and non-participation.

Can you review my managed care contracts?

Yes. This is a separate service from our billing package. We have read hundreds of managed care contracts and can explain to you the pros/cons of signing them because we are familiar with the frequent terms and conditions used in managed care contracts.

Can you handle past-due accounts and outstanding claims I currently have?

Yes. However, the fee for handling outstanding patient accounts or claims from dates of service prior to our start date will be separate and distinct from the regular billing package.

Are you a collection agency? Will you work with collection agencies?

No, we are not a licensed collection agency.