Services

We can tailor our services to meet your needs in many ways. Here are some of the services we offer: full revenue cycle management, assistance with staff training, specialty specific educational in-service,  data entry of all demographics and daily charges, claims submission and follow-up, patient payment plans, denials management, chart audit services, new provider credentialing, assistance with insurance eligibility and verification, and ERA/EFT Enrollment.

PRACTICE EVALUATION

We will come to your office to gather information and make observations. After careful review of this information we will determine which services will be beneficial to you and the cost for those services. Our fees typically range from 6-7% (check to see if your state allows % billing), flat fee depending on volume, or a per claim fee.

CLAIM SUBMISSION
Electronic claims submission is done on a daily basis to ensure consistent cash flow. Our billing specialists review all client patient data and carefully enters it into our billing software.  If you are working on an EMR system or other billing platform, we would review your new patient info and all billing before any claims are sent.   Once this daily process is complete and balanced, our medical billing software is used to ‘scrub’ claims for errors before it is released electronically to the insurance company. This allows us to instantaneously correct claims to speed up the payment process.

CLAIM FOLLOW-UP
Persistent daily claims follow-up is provided to include payment status, partial payments, denials and successful insurance appeals. Our software has many reports that provide quick status of all claims. We analyze claims payment on a daily basis to make sure optimal reimbursement is received.

INSURANCE PAYMENT POSTING
All payments by paper check will be sent directly to your business office. We highly recommend that you receive payments via EFT (electronic funds transfer to your bank) which is much faster than paper checks. Once you are enrolled with EFT’s we will set you up for ERA’s so that we have quick access to payment and denials from the insurance company. These ERA’s are delivered directly to our billing software and may even arrive before you receive your payment. All payments are posted daily to ensure the most accurate account information. Denials and underpayments are managed daily by our team.

PATIENT BILLING
We will bill your patient’s for their share of cost once the EOB/ERA has been posted. If your patient forgets to make payment/copayment in your office or after receiving their statement we will make several points of contact to obtain full payment or set up a payment plan. All account inquiries are handled promptly, professionally and always friendly. We want your patients to have a great experience not only with their Physical Therapist, but the billing as well. We employ bilingual Spanish/English employees so no communication barriers exist. We know how important your patients are to you and with that we are committed to excellence.

Optimal does not perform collection activity (credit reporting) services, however, we do partner with third-party collection agencies for account resolution. No accounts are sent to collections without prior approval from your owner or office manger.

APPEALS
Since insurance companies make no verbal or written guarantee that a claim will be paid, our team will work aggressively on all unpaid or wrongfully denied claims to secure payment. We have extensive knowledge in payer denial trends and those will be addressed immediately. If you don’t get paid we won’t get paid. This ensures that we work hard to make sure all claims get processed appropriately.

REPORTS
All reports are sent on a monthly basis free of charge, to provide practice performance reviews offering insight into practice growth and financial operations. In addition, Optimal provides remote access to our billing software so that you and your staff can have real time access to all patient accounts, as well as, access to many lists, reports, patient paperwork, and insurance company information.

MEDICAL CHART AUDITS

We know that our providers are busy treating patients and sometimes the documentation may not be sufficient to justify the insurance company’s definition of medical necessity. For this reason, we highly suggest partnering with an outside chart audit service to make sure your documentation is Medicare compliant. This will ensure minimal financial loss due to insufficient medical chart documentation or any coding error should you be subject to a chart audit.  New:  We hired an excellent Physical Therapist with experience working for an insurance company doing physical therapy chart reviews and authorizations.

HIPAA compliance

We utilize a customized compliance program and are HIPAA compliant. We are committed to safeguarding all medical, personal and patient information. All employees of Optimal are HIPAA trained on an annual basis and compliant.

Consulting

We offer revenue cycle management and practice management consulting. We continue to add and improve upon our services and technology based on what we can do to make our clients jobs more efficient and easier.

Member of AMBA– American Medical Billing Association

We hire CMRS “Certified Medical Reimbursement Specialist”.

Call us toll free today! [844] 891.7564