So, how would this integrate into your practice? Let’s say Action Billing Management is a member of Team You, and that a new patient contacts you and sets up an appointment.
That patient would call ABM, your billing office, with his insurance information and some basic demographic information. ABM would investigate his benefits. We would find out
- which insurance company to bill,
- whether you are an in-network or out-of-network provider,
- whether preauthorization is needed (and obtain it if possible),
- what to expect the insurance company to pay and
- what the patient’s financial responsibility will be.
ABM would send this information to you. We would also call the patient back and tell him what we learned from his insurance company. Both you and your new patient know what his responsibility is before the visit occurs. There are no surprises.
Once the visit has occurred, you notify ABM, and we submit a claim on your behalf.
We also send monthly statements to your patients. If your new patient paid you at his visit, that would be reflected on his statement. He would be able to see all charges and payments on his account. If he has any questions, he can call ABM directly.
What happens with the claim depends on how the insurance company processes it.
- If the claim is paid as quoted, the insurance company sends a check made out to you to ABM’s secure PO Box. ABM credits the patient’s account and deposits the payment into your bank account.
- If the claim is not paid as expected, ABM follows up. We call the insurance company. We request review and reprocessing. We appeal if needed.
ABM peruses your insurance claims. You do not have the hassle, but how do you know what is outstanding? How do you know what is owed to you?
ABM sends you monthly aging reports. You can see the outstanding amount for each of your active patients. If you have any questions about any of the accounts, just call. ABM works for you.
That’s how it works. ABM handles the claims and statements for your patients. You are free of the time commitment and stress of getting insurance companies to pay your claims.