Frequently Asked Questions

How does it work?
Billing Simplicity utilizes Office Ally’s free to low-cost software both for electronic claims submission and practice management. A HIPAA compliant cloud based approach allows ease of communication between the billing service and the provider to ensure that services rendered are recorded and accessible in real time to the billing service so that claims can be generated in a timely manner. Claims are submitted at least once a week to the appropriate insurance carrier.

Is there a long-term contract or time commitment?
No. You are welcome to try out Billing Simplicity for any length of time. You may discontinue engaging Billing Simplicity services by simply providing 30 days’ notice and a written request.

How do I provide you the data?
I will work with you to determine the best and most efficient way to exchanging data. Many providers have found that utilizing a web based log sheet has been easy, efficient and reliable. EOBs are scanned into a HIPAA compliant secure cloud based drive where I access them and record them or they may be sent by priority mail.

Where do payments go from insurances and patients?
All payments are mailed directly to you, the Provider. Billing Simplicity does not receive any of the payments, but simply records the data to ensure payments are remitted in a timely and accurate manner.

Are you HIPAA Compliant?
Yes. Billing Simplicity follows HIPAA guidelines regarding protected health information (PHI) and patient privacy. Our software vendor and clearinghouse for billing electronic claims are also certified HIPAA compliant. Our HIPAA policies are outlined in the Business Associates Agreement which is provided to all providers who engage Billing Simplicity’s services.

What if I am not sure if I want to be on any insurance panels?
I can assist you with looking at your client/patient demographic to determine if it benefits you to join insurance networks. Sometimes it is in the provider’s best interest to not accept all insurances due to low reimbursement and varying goals of their practice. Other times, it may allow you to expand your reach and be more accessible, while still being beneficial to your practice from a fiscal point of view.

An important and simple question to consider is – are patients turning elsewhere because you do not accept their insurance? Beyond this question, you will want to consider the reimbursement rates of the various insurance companies to see if it really is worthwhile to contract with that insurance. Alternatively, you might consider billing as an out of network provider as sometimes the reimbursement is higher (even though the patient’s policy pays at a lesser percentage).

Can I bill insurance carriers that I am not in network with (i.e. as an out of network provider)?
Yes, absolutely. You and your patient will need to be mindful in knowing that payment by the insurance carrier will typically be at a lesser rate and often with higher deductibles to meet. In this case, it is important to check with the patient’s specific plan beforehand so that there are no surprises.

Additionally, as the Provider, are not required to take any adjustment or write off like you would if you were contracted. You may ‘balance bill’ the client. This means that if the insurance allows $85 for a service that you charge $130 for, the difference of $45 is the amount you can balance bill your patient. Keep in mind that the patient’s policy might indicate the out of network benefits are payable at 60% so the insurance will pay 60% of $85 = $51. You then charge the patient $34 remaining plus the balance billing amount of $45. The total payable by the patient is $79. In this case, you recoup your full charged rate of $130, though many patients will likely find a provider that is in network with their policy to reduce their fees.

Can I offer a discount to my clients? Are there rules?
Ethically, best practice indicates that “what you do for one, you do for all.” So, with any discount you extend to any of your patients, you will need to ensure that this same discount is offered to all your clients who are in similar situations.

You might decide to offer a sliding scale fee charging variable amounts based on the patient’s income situation. In this case, ensure that your approach is systematic and objective with a consistent process to determining fees for all your patients.

Additionally, you might decide to offer time of service payment discounts. In this case, you could incentivize your patients to pay at the time the service is rendered by offering them a discount of 20% (or any amount). Keep in mind, this time of service discount should not be made available to those patients for whom you are billing insurances that you are contracted with, because you are obligated to the fees set forth by the contract.

Can I utilize your services to start with the intent of eventually doing my own billing?
Absolutely. I will set you up with Office Ally, a free to low cost electronic claims clearinghouse, and you will have full access right away. This allows you the option of taking over your billing at any time or to simply login and check patient accounts or review reports while I am handling your billing. My goal is to work with you and to assist you in simplifying your life when it comes to handling insurances and money in your private practice.