Please review some of our most commonly asked questions and for any further information, please CONTACT US today!
1. Who is Regal Billing?
We are a medical billing service company in Morrisville, NC that specializes in claims submission, credentialing, accounts receivable recovery and/or full service billing. We offer full or partial billing services to any provider based on their particular needs. We can perform billing services for providers of any specialty within any state.
We have been involved in the healthcare industry for over 10 years, and we have established an affordable business model that caters to the specific needs of small to mid-sized practices. Our fees are directly correlated to the overall success of our clients. If a provider’s claim volume goes up, our fee will go up. If their claim volume goes down, our fee will go down.
2. Why would I want to use Regal Billing?
We are one of the few billing service companies that come from an IT background centered around HIPAA implementations; where our experience in programming and EDI provides us with a unique knowledge base for fulfilling the billing needs of our providers. As the healthcare industry increases its reliance on technology, our unique background allows us to standout from our competitors. We understand all of the different billing and technical issues that most providers encounter, and our experience allows us to solve these problems in a timely fashion to prevent any delays in reimbursement.
Additionally, we are fully aware that many healthcare providers are on tight budgets, and there’s a limit to how many services they can actually outsource to a medical billing company. We also know that most providers do not have the internal resources necessary to dedicate to an ever-changing and more complicated insurance industry. Due to these factors, we have established a business model that can be customized to the specific needs of each provider; and will increase a provider’s cash flow, and reduce their billing issues, at an affordable and manageable cost.
3. What is HIPAA?
HIPAA stands for Health Insurance Portability and Accountability Act. It’s a law that was passed by Congress in 1996 mandating the rules through which all entities involved in the healthcare process must follow in order to do business. There are many provisions under the HIPAA law, such as establishing the universal standards for transmitting healthcare data electronically, as well as addressing the security and privacy concerns for protecting patient health information (PHI). All healthcare entities must conform to the HIPAA guidelines; otherwise they won’t be able to do business going forward. Any violation of the HIPAA privacy and security provisions could result in stiff penalties, and in some cases, jail time. The main purpose of HIPAA is to streamline the healthcare process to eliminate billions of dollars a year that is wasted on administrative costs.
4. What is EDI?
EDI stands for Electronic Data Interchange and it’s used to represent the electronic formats of standard business documents. Under the Administrative Simplification portion of the HIPAA law, the EDI format was chosen to represent how healthcare information was to be transmitted electronically.
The EDI format that represents a Professional healthcare claim (HCFA) is referred to as an 837P transaction. The EDI format that represents an Institutional healthcare claim (UB) is referred to as an 837I transaction. Due to the adoption of this standard, all healthcare entities are now able to program their systems based on the same universal formats; which streamlines the claim adjudication process and saves billions of dollars a year in administrative costs. All billing software, clearinghouses, payers and third-party administrators transmit their data as EDI transactions.
5. What is a clearinghouse?
A clearinghouse is a centralized hub through which providers can submit their claims and have them routed to the appropriate payer. Each payer who receives electronic claims is assigned a specific Payer ID# that will determine where submitted claims will be sent. (You can think of the Payer ID# as an electronic address for each insurance company.) If a payer does not receive electronic claims, then the clearinghouse will print the claim on paper and have it mailed. Using a clearinghouse allows providers to have one method for submitting their claims. Providers will no longer have to deal with the manual intensive task of printing and mailing in claims, or having to go through multiple different interfaces; such as logging into each payer’s specific website.
6. How do I get started with Regal Billing?
Any provider interested in using our services would need to fill out a Client Registration Form that we would send them through fax or email. This form captures the information that we need in order to register a provider with the clearinghouse, such as Service and Billing Addresses, Specialty, TIN or SSN, NPI (Type1 and Type 2), etc. (Please contact us if you’re interested and we can send you this form.)
7. Do I have to sign a contract?
No, but we do offer a contract in case a provider would like to sign one. We do not keep our providers locked into our services for any length of time. A provider who utilizes our services can leave any time they wish. (Note: The only thing we do ask a provider to sign is a HIPAA Chain of Trust agreement confirming that they will abide by the HIPAA privacy and security guidelines.)
8. Is there an intial setup fee?
No. The first time we charge a provider for our services will be after their first month of claims submission.
9. How do you submit our claims?
We will register a provider with our clearinghouse and submit their claims using our web-based software application. We follow the HIPPA privacy and security guidelines protecting patient health information (PHI), and all transmissions will be submitted over a secure server.
10. How long does it take to get setup before I can start submitting claims?
It will only take a couple of days to get a provider setup to submit their claims electronically to a commercial payer. However, depending on the state where the provider renders services, there are certain payers, like Medicare, Medicaid, or BCBS, that require separate EDI applications to be filled out before we can start submitting claims to those payers. It usually takes 2-3 weeks for those applications to process. (Please ask us which payers require separate applications for your state).
11. How do I get you my billing information and when should I send it?
Due to our extensive technical background, we are always looking for ways to use new technologies that will allow us to provide our services in an efficient and effective manner. Thus, we utilize a new software application that will create a shared folder on each provider’s individual computer. Within this folder we will post our simple and straightforward billing forms that each provider would use to enter in their billing data. When ready to submit, a provider will save their billing information to this shared folder and then send us an email indicating that it is ready to be picked up. By posting claim information to this shared folder, we avoid any potential HIPAA violations that could arise from transmitting data through email or fax. In addition, there will always be an archived copy of all billing data posted that we can look back and refer to whenever necessary. Most providers send us their billing information either weekly, semi-monthly, or monthly. (NOTE: For some providers we do allow them to fax us their billing data if their own practice management software prints it out on a standard HCFA or UB form.)
12. Do you submit both Professional (HCFA) and Institutional (UB) claims?
Yes. We are one of the few billing services companies that can submit claims for both individual providers and clinics\facilities.
13. Do you handle Workers Comp claims?
Yes, we handle Workers Comp claims, and we will follow the billing guidelines specific to each payer.
14. Do you submit to all insurance companies?
Yes. We submit to any payer that accepts a HCFA or UB claim.
15. How long do you wait before submitting the claims you receive?
Usually we try to get all claims submitted within 2-3 days, but sometimes it may take longer depending on how many batches we get that week. However, all claims will be submitted sometime within the first 7 days after we receive them…no later than that.
16. How do I know when our claims have been submitted?
After each claims submission we will post a batch report to the provider’s shared folder and then send them an email indicating that it’s ready to be retrieved. The provider can access these reports any time they wish to verify that all claims have been submitted.
17. Will any insurance payments or EOB’s be sent directly to you?
No. We do not have any claim payments or EOB’s mailed directly to us. All we do is submit a provider’s claims and any correspondence will still go directly to them. (NOTE: If a provider utilizes our full service billing option, then we will fill out the necessary paperwork to have ERA information sent directly to the clearinghouse to be used for claims reconciliation and payment posting, but the actual payments would still go directly to the provider. If a provider only uses us as a partial billing service, then we would NOT set this up.)
18. Since you reside in NC, can you still submit claims for providers in other states?
Yes. We can submit claims for providers in any state. The billing service and provider DO NOT have to reside within the same state.
19. Do you give referral bonuses if we recommend your services to other providers?
Yes. If you refer any providers towards our business and they end up signing up for our services, we do offer a referral bonus that will vary depending on which of our services you utilize.