DATAIPO  LLC

​Revenue Cycle Management Services (Billing)

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• HIPAA Compliant.

• Turnaround time = within 2-3 business days (depending complexity and/or volume of work).

• Default  Application(s) = Office Ally, SimplePractice, Cerner, SSI, EZ Claim, FundEZ, Medicare / Connex, Medicaid / ePaces, Clearinghouses, Others: can use your In-house application), Major Insurances 'Online', Uploads / Imports, Quickbooks, Google: Drive, Folders, e-mail, Calendar, Docs, Sheets, Microsoft Office: Excel, Word, Access, PowerPoint, Project, Windows Automation.

• Agreement on Statement of  Work = After we agree on: the stakeholders, timeline, application(s)/access used and the fee, payment method  by signing and dating the information will be processed and completed within the agreed turnaround time.

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• Payment Method =  Square, Zelle, Credit Card      

  • Frequency =  Weekly (or as per contract)

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• INSURANCE COMPANIES (PAYERS): Experienced extracting data and working with most major Insurances (for example, not limited to: Cigna, Aetna, BlueCross BlueShield (Availity), United Healthcare, UMR, Carelon (Beacon Options), Medicare-Connex and Medicaid-ePaces). Effectively navigate through the various web sites (verifying, uploading/ downloading: Remittances, Claims, Claim Status, any Denials) and/or calling and working with Insurance Representatives in an effective, courteous, and professional manner on behalf of Providers.

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• PRICING (Suggestions, negotiable):

       

1.  SELF PAY / NOT PARTICIPATING with INSURANCE SERVICES:

• Post Visits and Maintain Balances per Date of Service =  $4.00  / per date of service

• Service Includes:

  • Payment Verification, understanding and agreement

  • Client Document verification (collection/confirmation of Signed and dated Forms: Demographic, HIPAA, Self Pay, Cancellation/No Show, IDS, etc.)

  • Keeping an Accurate Balance per Patient, Posting Payments: Cash, Check or Credit Card to the specified accounts

  • Working with Aging Reports

  • Revenue Reports on agreed frequency

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            2.   CODING and BILLING SERVICES:

• Submit Claims per Date of Service (DATAIPO LLCs Re-submissions/ any error fixes are NOT charged) =  $4.00  /per date of service

• Medicaid: ePaces, Medicare: Connex  (Inpatient & Outpatient may be separate, depending on the US State - discuss)

• Insurance Eligibility Verification (Effective Dates, Deductible status, Copay/ CoInsurance, Services covered) and/or Pre-Authorization/ Pre-Certification Management (Work with Insurance to: Inquire, Obtain and Monitor) =  $3.00  /per New Insurance Verification and/or Authorization Number, per pertinent patient

• OveIrall Service Includes:

  • Insurance Verification, any co-payments, understanding and agreement

  • Client Documentation (verify the collection/confirmation of Signed and dated Forms: Demographic, HIPAA, Cancellation/No Show, IDS, etc., Insurance: Card Images (front & back))

  • Claim: Coding/ Creation, Submission and Follow up

  • Working with Aging Reports

  • Review and fix possible errors (Re-work Denials, look out for Patterns)

  • Posting Accounts Receivable (in Office Ally) -  work with EOBs (paper) / ERAs (web) Remittances (Payments)

  • Revenue Reports on agreed frequency

 

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            3.    ADDITIONAL SERVICES:    

• Fixing of Prior Claim issues (prior to DATAIPO LLC's service start date with you) =  $4.00  /per date of service 

• Your FEE Schedule(s), new Additions / new Updates PER Payer =  $5.00   /per Payer

• Direct Deposit / Electronic Funds Transfer (EFT) Set Up Service (per Provider):

  • EFT Set Up - Retention Fee (one time) = $25.00

  • EFT Set Up - per Insurance Panel = $10.00

• Patient/Client Services: 

  • Statements/Invoices: first 10 = Free, after 10 =  $0.50  /per statement (invoice)

  • Appointment Reminders: there needs to be a Scheduling system set up, fee=  $29.99  (includes 500 calls)

    • Over 500 call reminders =  $10.00 /per hour

• Custom Reports / Data Analysis (not Aging Reports) =  $40.00+   /per report

• Consultations / Meetings  as requested by Client =  Initial (1 hour duration) = Free,  All others = $40.00  /per hour

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4.   CODING and BILLING SYSTEM MAINTENANCE SERVICES:

 

• Initial Set up to start billing (using DATAIPO LLC's Clearinghouse = OfficeAlly): = No additional Fee.

  • Service Includes: agreement in the Contract/Statement of work, such as:  creating your business(s) profile(s), provider(s) profile(s), fee schedule data,  importing/entering all your client data, all pertinent templates and using Aging reports.

    • Note: most of your client data is transferable to your own Clearinghouse/Billing System whenever you need it or when the contract has ended.

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• To Start billing in Your Own established Clearinghouse / System (make a few approved only updates to existing/additional info.: business, provider, client, fees, template, reporting) = No additional Fee. 

•  Just give DATAIPO LCC temporary access.

  • Service Includes: creating/updating patient demographic, assigning codes, billing and any other agreement in the Contract/Statement of work.

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• Set up a Clearinghouse for you (nothing set up/configured) =  $200.00+, based on the size and complexity of the project.

  • Service Includes: execute Project Management,  Get the free OfficeAlly web application (or any other) for your practice, do Organizational Review based on your Business set up (or any established Revenue Management Process), create Profiles (Business, Administrator, Provider(s), Staff-Type(s), Set up Fee Schedule data, exporting, importing and entering all your existing and new Client data, set up all pertinent Templates, Staff ID allocation and Staff Training.

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 Process Summary:

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  INPUT =  Simple and Secure  

• Get Temporary and Secure Access to System(s)/ Share drive/Web page URL for processing -OR- Send Attachment/Scanned/FTP documents for processing.

• Confirm Business, Group and/or Provider's information: ID and Tax information, Panel information, Fee schedule. 

• Gather each patient/client information for Claim creation: confirm signed and dated demographic, HIPAA and  Authorization documents, verify Insurance Benefits-images, process Demographic, confirm Diagnosis and Procedure.

 

  PROCESSING = Quick and Efficient  

• Insurance Verification: check eligibility, deductible, copay, any authorizations.

• Coding: based on the Provider(s) input, the current ICD-10, DSM-V, CPT, and HCPCS Level II manuals assign the correct Diagnosis and Procedure codes and create Claims. 

• Billing: submit Claims for Insurance Companies to reimburse based on your fee schedule.

• Follow up on Claims: (as agreed) ensure they are processed (no denials, rejections or errors).

 

  OUTPUT= Accurate and Timely Filing

• Accounts Receivable: ensure that the Insurance Companies have reimbursed the providers. If agreed, allocate the funds to the appropriate accounts.

• Reporting/Metrics: (as specified in the agreement) prepare Aging Reports or Custom reports based on the desired frequency (weekly , etc.).

• File handling: all files are secured in the system once the coding/billing is completed (or filed in the agreed manner).

• Disable any Temporary ID(s)  [AFTER PROJECT COMPLETION].