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Surprise Medical Billing Policy Update

  • by vmvbrands

In late 2020, the Consolidated Appropriations Act, 2021 (CAA) was signed into law. What this law does is stop surprise billing and sets new transparency requirements.

These provisions would go into effect at the beginning of 2022. There are three regulations going into effect to help the implementation of the provisions.

Learn more at https://www.mcdermottplus.com/insights/healthcare-policy-update-surprise-medical-billing/

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302 Hickman Rd, Suite 102
Charlottesville, VA 22911
Copyright © 2024 IMBS Inc.
All Rights Reserved

Website by VMV Brands
Office (434) 984-4627
Fax (434) 984-4622
Reporting and Analytics
  • IMBS has an array of reporting options available to our providers. Reports we can provide upon request:
    • A/R aging
    • Collection status
    • Coding analysis
    • Charge/payment/adjustment analysis
    • Payor mix
    • Financial class
    • The standard End of Month reports that are given with your invoice include Till Reconciliation Summary, Insurance Payments Detail Report and Unposted Patient Prepayments report.
Insurance Clearinghouse Enrollment
  • With your properly filled out paperwork, the IMBS team can get you up and running with insurance filing and electronic remits through our clearinghouse. This will ensure your claims get filed timely and accurately. Electronic filling is the preferred option for the whole revenue cycle since reimbursement is much quicker than filing on paper claims.
Patient Collections
  • At IMBS, we have a varied schedule for our collections process. Upon signing a contract for services with IMBS, a provider is able to establish one of 3 options for their collection needs. For most of our practices, a patient is able to call and make a payment over the phone. IMBS does everything within the protocol to ensure the patients do not go into a collection status. Reminders are sent regularly and we afford the patients many opportunities to pay their remaining balances with the providers.
  • If we need to move forward with an outside agency, we will attain permission from their provider prior to sending a final notice to the patient.
  • Only when all measures are exhausted will we submit the patient data to our outside agency for further attempts to get payment on the patient account.
Patient/Provider Inquiries
  • At IMBS we believe that our providers and their patients are valuable. We are dedicated to answering their questions when they call. A live representative will courteously answer when you call and help you with your billing questions. We are advocates for our physicians and clinicians and are happy to help resolve any issues you may encounter.
Patient Statements
  • If there is still a balance left to the patient on an invoice, after we verify all insurance on file with IMBS has been billed accurately, then we send the patient a statement. If a patient has a question or concern regarding his or her statements, they are welcome to call our office for clarification. We are willing to work with the patient as per their provider protocol to get their account balances paid. Most offices accept credit cards and we will be happy to accept that on their behalf.
Appeals/Denials & A/R
  • Our staff is trained to detect and correct Accounts Receivable errors and denials. They actively work on claims that are outstanding after 45 days and are in communication with insurance companies daily to appeal and correct errors and denials. We strive to have the upfront claim process correct the first time around, but if insurance denies, our A/R team is there and ready to follow through to get your claims paid.
Remittance Posting
  • Most payments paid by insurance will filter through the clearinghouse as an ERA (Electronic Remittance Advise). These ERA’s get posted to the patient’s accounts. Any claim received on a paper remittance notice will be sent to the Practice and should then be forwarded to IMBS for manual posting by our billing staff.
  • Our billing specialists study each EOB (Explanation of Benefits) for proper payment and/or denials. If a payment is not processed properly or denied inappropriately, our billing team will work with the A/R team to get this corrected and resubmitted for payment.
Electronic Claims Submission
  • After we carefully review each CPT code, DX codes, Modifiers and HCPCS codes, we send claims via electronic submission. We monitor claim files for acceptance from the payors and work on denials that come back to us unprocessed. Attention is given to each claim denied at the payor and clearinghouse level.
HIPAA Compliant Staff
  • Our staff is fully trained on the complex world of compliance. Protecting your practice is our top priority. Each year our staff at IMBS goes through training on the newest rules and regulations ensuring they are informed and knowledgeable.
  • Outsourcing to a trustworthy company is key to any practice but practices need more in terms of keeping up to date HIPAA regulations. At IMBS we will do our part and happily give your office advice when needed.
Coding and Research Support
  • Most claims are coded by our providers in office. At IMBS, we offer to review codes for accuracy and have certified coders for those complex coding issues.
  • We research the top coding sites for issues that need special consideration and we verify each code used.
  • We have the most current coding resources and books always available to use if questions arise.