Insurance Billing Solutions is your physician’s patient and insurance medical billing contractor.  Our office works closely with your Physician and staff to accurately submit claims to your insurance carrier for adjudication, to interpret and apply your insurance carrier’s assignments, and to process patient statements per your contract with your medical insurance carrier.  Processing medical claims is a complicated action that requires exceptional communication between the patient and the physician’s office, between the patient and Insurance Billing Solutions, and between the patient and their medical insurance carrier. Accurate and precise patient demographic information and patient insurance profiles must be correctly populated into the data base that your physician maintains.  As your Physician’s authority on the Medical Billing Process, you are welcome to contact Insurance Billing Solutions or your Insurance Carrier if you have questions or concerns about the claim adjudication process, statements, or about eligible benefits.

Call our office:  561 354 9027
Email our office:  info@insurancebillingsolutions.com

Insurance Billing Solutions
801 Northpoint Parkway, Ste 39
West Palm Beach, FL  33407

Contacting Insurance Billing Solutions?  If we cannot live answer your call, please understand that our billing specialists are on the phone throughout the day speaking with other patients or insurance carriers.  If you are transferred to voicemail, please leave a detailed message that should contain the patient’s name, the patient’s call back number, and the patient’s physician with a brief description of why you are calling.  Our billing specialist will access and analyze your account and return your call.

The medical billing process is a series of steps completed by your physician, office staff and medical billing specialists to ensure that medical professionals are reimbursed for their services. Depending upon the circumstances, it can take a matter of days to complete, or may stretch over several weeks or months. Here is a general outline of a medical billing workflow.

Patient Registration

• Patient registration is the first step on any medical billing flow chart. This is the collection of basic demographic information on a patient, including name, birth date, and the reason for a visit. Insurance information is collected, including the name of the insurance provider and the patient’s policy number, and verified by office staff. This information is used to set up a patient file that will be referred to during the medical billing process.

Financial Responsibility

• The second step in the process is to determine financial responsibility for the visit. This means looking over the patient’s insurance details to find out which procedures and services to be rendered during the visit are covered. If there are procedures or services that will not be covered, the patient will be financially responsible for those costs.

Superbill Creation

• During check-in, the patient will be asked to complete forms for their file, or if it is a return visit, confirm or update information already on file. Identification will be requested, as well as a valid insurance card, and co-payments will be collected. Once the patient checks out, medical reports from the visit are translated into diagnosis and procedure codes by your physician. Then, a report called a “superbill” may be compiled from all the information gathered thus far. It will include provider and clinician information, the patient’s demographic information and medical history, information on the procedures and services performed, and the applicable diagnosis and procedure codes.

Claims Generation

• The medical biller will then use the superbill to prepare a medical claim to be submitted to the patient’s insurance company. Once the claim is created, the biller will review it carefully to confirm that it includes standards for medical coding and format.

Claims Submission

• Once the claim has been checked for accuracy, submission is the next step. In most cases, the claim will be electronically transmitted to a clearinghouse, which is a third-party company that acts as a liaison between healthcare providers and health insurers.

Monitor Claim Adjudication

• Adjudication is the process by which payers evaluate medical claims and determine whether they are valid and compliant, and if so, the amount of reimbursement the provider will receive. During this process, the claim may be accepted, rejected, or denied. An accepted claim will be paid according to the insurer’s agreements with the provider. A rejected claim is one that has errors that must be corrected, and the claim resubmitted. A denied claim is one that the payer refuses to reimburse.

Patient Statement Preparation

• Once the claim has been processed, the patient is billed for any outstanding charges. The statement generally includes a detailed list of the procedures and services provided, their costs, the amount paid by insurance and the amount due from the patient.

Statement Follow-Up

The last step in the medical billing process is to make sure bills are paid. Medical billers and physician office staff must follow up with patients whose bills are delinquent, and, when necessary, send accounts to collection agencies.

These are your best options for how to check if your doctor is in-network:

1. Sign-in to your insurance company website for an updated network list.
2. Call your insurance company using the member services line, which you can usually find on your insurance card. After confirming that your physician is in-network, obtain a reference number and provide this reference number to your physician’s office staff so that they can include this information in your chart in the event your insurance denies future claims for out of network status of your physician.
3. If obtaining a new insurance, contact the insurance company to confirm that your physician is in network while obtaining a reference number to document the status.

The patient will receive an Explanation of Benefit (EOB) from your medical insurance carrier,after the claim has been adjudicated by the medical insurance carrier.  The EOB is not a bill, although it will explain any charges that the patient still owes or may have already paid (in the form of a copay at the time the medical care was received, for example). If the patient owes additional money after the insurance company has paid its portion, Insurance Billing Solutions will send a separate bill, which should match the patient’s portion listed on the EOB.

If your claim is rejected or denied due to in-eligibility, then you will receive an informational statement from Insurance Billing Solutions that requires an immediate action on your part with subsequent contact to Insurance Billing Solutions to clarify your discussion with your insurance carrier and remedies.  Request a reference number from your insurance carrier and provide the reference number to Insurance Billing Solutions when contact with your insurance carrier is requested.

If your claim is denied, or if your insurance carrier applies a cost share that you disagree with, then you can appeal your insurance carrier’s decision by contacting your medical insurance carrier.

1) Contact your insurance carrier and request clarification of your patient assignment or reason for denial. 

2)  Inquire if this claim was adjudicated according to your contract. 

3) Request a reference number from the carrier following their explanation.

4)  Contact Insurance Billing Solutions to provide the REFERENCE NUMBER and a brief description of your call with your Insurance Carrier.  Insurance Billing Solutions will notate the REFERENCE NUMBER in your chart for subsequent contact by our office to your insurance carrier to assist your resolution with your dispute.

5)  If carrier has determined that the assignment was adjudicated “to contract”, remittance of your balance shall be made to your physician’s office to the address as indicated on your statement.

What is a reference number?
A reference number is aunique numeric or alphanumeric identifier assigned to your communication file that documents the reason for your call to your insurance representative.  Reference numbers make it easier to locate and identify your conversation in your insurance database.  Reference numbers are useful to Insurance Billing Solutions as the reference number can be included in your claim for reprocessing or follow up with issues with your medical insurance carrier.  Always provide the reference number to Insurance Billing Solutions or physician’s office staff.

You are receiving a balance due statement because of your medical insurance carrier(s) adjudicating your claim as patient cost share applied as patient co pay, coinsurance, or deductible in accordance with your contract with your carrier. Please contact your carrier for clarification of pending balance– OR- You may contact Insurance Billing Solutions for clarification.

What is a patient cost share?

• Copayment – a form of medical cost sharing, as indicated in the contract between the patient and the carrier, in a health insurance plan that requires an insured person to pay the physician a fixed dollar amount when a medical service is rendered.
• Coinsurance – a form of medical cost sharing, as indicated in the contract between the patient and the carrier, in a health insurance plan that requires an insured person to pay the physician a stated percentage of medical expenses after the deductible amount, if any, was paid.
• Deductible – a fixed dollar amount during the benefit period – usually a year – that an insured person pays to a physician before the insurer starts to make payments for a covered medical service(s).  An insurance deductible is the amount the insured is required and obligated to pay by the insurance policy, as indicated in the contract between the patient and the carrier.

Insurance Billing Solutions requires remittance of your balance upon receipt of the statement to avoid duplicate billing and duplicate payments.

How to pay your balance?

• Mail a check with the statement receipt to your physician’s mailing address, or
• Notate your credit card information on the receipt of the statement and mail this receipt to your physician’s mailing address, or
• Contact your physician’s office by phone and provide your credit card information for payment, or
• Contact Insurance Billing Solutions by phone and provide your credit card information for payment.

Balances that exceed 31 days are past due and are automatically placed into collections status which may result in emails and telephone contact by office staff to collect the past due balance.  Patients with seriously past due balances may result in credit privileges being revoked and account may be placed in “Inactive Status”, and your bill may be forwarded to a collections agent.  Avoid possible damage to your credit, our office recommends that payments are due upon receipt of the first statement.

Occasionally our office will send you an “informational statement”.  An informational statement is requesting some type of action on your part to resolve an issue.  Although remittance is not required for an “informational statement”, the statement indicates that if the patient disregards the action, then the balance may become patient responsibility. 

What actions are required if you receive an informational statement?

a)  Review the statement for the action

1. If contact with your insurance carrier is required with subsequent contact to our office, always obtain a reference number by requesting a reference number from the Insurance Customer Service Representative.
2. Be prepared to give this reference number to Insurance Billing Solutions when you discuss the requested action with our office.
3. Our office requires the reference number to refile claims to the insurance carrier.
4. If your claim was denied due to ineligibility, contact our office with your updated insurance profile so that we may resubmit the claim to the correct carrier under the correct member identification number.
5. Patient inaction may cause the claim to be denied and the balance will be due by the patient.  Insurance Billing Solutions recommends that the patient immediately responds to informational statements with the recommended actions to avoid possible patient liability for inactivity.