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.
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.)
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.)
Please click here and submit our NEW client questionnaire so that we may access your practice needs and determine rates.
We support several substance abuse treatment facilities, as well as MD’s, DC’s, PT’s and LP’s.
Our services can be used regardless of your network status with insurance companies.
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.
We will maintain authorizations until the member is discharged.
…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.
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.
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.
Weekly, we generate a 30+ Day Insurance Aging Report that identifies outstanding claims and we work this list in its entirety.
Frequent billing ensures a steady cash flow for you and we recommend billing daily wherever possible.
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Yes, Optimal RCMS realizes the importance of dedicated staff and we do our part to ensure you receive personalized attention.
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.)
Yes we partner with a clearinghouse to assist us with EDI transactions.
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.
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).
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.
100% of our claims are submitted in compliant formats mandated by law.
Yes, many of our providers perform specialized services and we bill for them.
Yes, many of our clients elect to outsource to Optimal their Authorization processes.
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.
Absolutely, we partner with a National Provider Enrollment Company that offers exclusive rates to OPTIMAL RCMS and our customers.
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.
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.
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.
No, we are not a licensed collection agency.