Q: Is it smart to outsource my billing to a medical billing company?

A: It’s smart and good business to concentrate on your core competencies. For physician groups, this entails providing quality medical care – and outsourcing ancillary functions, like billing and practice management. Quality First Assist provides a full spectrum of billing and practice management services while maintaining transparency to our clients so that they can focus on their core competency and have confidence in ours.

Q: What kind of service does QFA provide?

A: QFA provides a full menu of revenue cycle management services including medical record receipt, coding/charge entry, claim submission, charge capture/reconciliation, payment posting, and AR follow up.  Other services QFA provides include practice management, scheduling, credentialing, and bookkeeping.

Q: How does QFA reduce my administration headaches and how can I benefit from your services?

A: QFA medical billing experts assume the burden of revenue cycle management and generate improved cash flow allowing you more time for patient care. We manage the billing staff and office and are responsible for hiring, training and supervision. We work with hospital departments and physician front offices to ensure accurate documentation and electronic transfer of data.

Q: Are you HIPPA – complaint?

A: Yes. QFA takes OIG and HIPAA compliance very seriously and has implemented needed controls and secure methods of data transfer. We work in concert with our clients to correct suboptimal processes.

Q: How does QFA charge for services?

A: Our fees are based on a % of net collections. There are no hidden fees.

Q: Do I need special software for you to do our billing?

A: No. QFA traditionally receives data electronically from physicians and hospitals. This is possible through an electronic transfer of demographic and, medical record data traditionally in the systems proprietary format. QFA billing software has practice management features that physician offices can use and physician offices using our software for practice management functions is an option.

Q: How soon can you take my medical practice on as a client?

A: QFA traditionally requires 60 days to implement new clients. Client size, number of interfaces, and enrollment of providers under a new entity are material considerations. This is a topic that is routinely discussed by QFA and client so that mutual goals are accomplished.

Q: What do you need from us to get started?

A: This depends on the services being offered.

  • For billing, we work closely with the physician front office and/or hospital department (as appropriate) to isolate the data types required to create claims, define exchange mediums, and determine the frequency/timing of data transfers. Any operational gaps would be identified and rectified by client and QFA.
  • For scheduling, we work closely to understand the requirements of the group so that an efficient process can be developed. As well, we would want to see existing schedule formats.
  • For bookkeeping/ Accounts Payable, we need employment agreements and direction on payroll processes and timeframes. As well, we need a list of standard vendors to whom payment is made, direction on accounts payable process and timing and designated check signers.
  • For Credentialing, we need standardized billing applications by provider, physician credentials, and other information needed to maintain physician, payer, and site credentials.

Q: What kind of report will I get?

A: We group reports generally into four different categories.

  • Claims-These reports come from our clearing house and show the volume of claims submitted by payer according to a specific timeframe.
  • Transactional-This provides data at the procedure and transactions level and allows querying specific types of procedures, claims, rending physicians, etc.
  • Practice Management/Custom-These are custom reports that can provide insight into referring physicians, payer mix by site, physician productivity, etc. In this arena, we work closely with the client to identify needs and customize reports that satisfy them.

 Q: Do you have any references we can contact?

A: Yes. We consider client’s satisfaction paramount and will gladly provide information to you on current and past clients for you to contact.

Services Schedule

Billing Services:

  • QFA shall perform coding as follows (a) analyze patient services described in clinical records, patient registration forms and other necessary documentation submitted to QFA by Client, (b) assign current procedural terminology (CPT) codes and (c) assign ICD-10 diagnosis codes. In providing coding services, QFA will follow the guidelines provided by the American Society of Anesthesiologists unless Client provides, in writing, specific guidelines of a different nature, including but not limited to base value, anesthesia modifiers, physician status, time units and concurrency guidelines.

 After receiving accurate and complete demographic, procedural and other required information from client, use reasonable efforts to enter all procedural and demographic data necessary for patient and third party billing into its billing system in timely and accurate manner.

  • Implement billing fee schedule provided by client for billing services.
  • Issue initial billings to patients and/or third parties in a timely manner after receiving all required information.
  • Submit claims electronically to all third party payers capable of accepting claims in electronic format, unless QFA determines, in its reasonable discretion, that submission of paper claims is preferable with certain payers.
  • Insurance filing, including analysis, follow up and, where necessary, appeals concerning denied claims.
  • Implement and post payments according to existing managed care contracts and fee schedules of client.
  • Respond to patients inquires and maintain an adequate phone inquiry staff to respond to patients in a reasonable amount of time.
  • Notification to client of any refund requests. Client will make decisions concerning refunds and where applicable, prepare and send refund checks, unless prohibited by third party payer rules or regulations. In such cases, Client will provide QFA a copy of a refund check or a written explanation of its decision not to provide a refund.
  • All monies, checks, drafts, or other instruments received on behalf of the Client shall be deposited to the Clients bank account.
  • Referral of overdue accounts to a collection agency.
  • QFA will be available to discuss billing and performance issues with Client on a regular basis. Meeting may be held at the offices of Client or QFA.
  • QFA will not implement or regulate any compliance policies for the Client. The Client shall be solely responsible.
  • QFA’s billing services do not include training of Client personnel or insurance verification, pre-determination, pre-authorization, retro-authorization or scheduling. If Client wishes to add these services, they are available for an additional fee.

Practice Management Services:

  • Use reasonable efforts to advise Clients with respect to any material change in third party rules and regulations which are made known to providers and third party billing agents.
  • Advise on practice growth and patient/payer mix.
  • Assist with management of administrative duties as mutually agreed.

Enrollment Services: Choose one

  • Option 1- Enrollment services consisting of preparation and submission of provider billing enrollment applications for governmental payers and designated commercial payers, managed  care plans, and IPAs.
  • Option 2- Enrollment services consisting of (1) preparation and submission of provider billing enrollment applications for all governmental and commercial payers, managed care plans, Ipas, and (2) credentialing of Client’s providers at hospitals and similar facilities, and (3) facilitating licensure of client providers.
  • Option 3- Enrollment services consisting of (1)preparation and submission of provider billing enrollment applications for all governmental and commercial payers, managed care plans, IPAs, (2) credentialing of Clients providers at hospital and similar facilities, and (3) facilitating licensure of Clients providers.
  • In connection with the previously described enrollment services, Client will (i) seek to notify QFA at least sixty (60) days in advance of the start date of any new provider, the opening of any new office or the occurrence of any other event that would require QFA to obtain or amend a provider number or enroll and provider; (ii) provide QFA will all necessary information enroll a provider prior to the date the provider begins rendering services on behalf a client, (iii) respond to any requests from QFA for information related to the enrollment services within seven (7) days; and (iv) immediately deliver QFA any applicable correspondence or written communications received from governmental or commercial payers, managed care plans, and IPAs pertaining to the enrollment services related to the enrollment services if client fails to comply with the requirements and time frames set forth in(i-iv) above.

Managed Care Contracting:

  • Negotiate managed care contracts.
  • Analyze existing contracts and fee schedules.
  • Advise on practice growth and patient mix.
  • Use reasonable efforts to advise Client with respect to any material change in third party rules and regulations which are made known to providers and third party billing agents.