Working with a Detached Biller

A detached biller is an outside contractor who performs insurance claims work on behalf of your company. The detached biller accepts run reports, and sends back EOBs.

AngelTrack was designed with this exact situation in mind, so that you can convert your operation to mobile/paperless/cloud without perturbing the relationship you already have with your billing contractor.

Certainly there are advantages to inviting your outside biller to integrate -- to make use (free of charge) of your AngelTrack cloud server... but if he or she is not interested in integrating, that's fine too.


An Urgent Warning About Detached Billers

Detached billers are hazardous to the health of your business. Learn the hazards so you can protect yourself...

This industry does not self-police and is not regulated

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The EMS billing industry does not self-police and is not subject to direct regulation, nor to required certifications. It is still the wild west.

There are certifications available (e.g. CAC, CACO, CAPO), but they are voluntary. Only about a third of EMS billers bother to get any of these certifications, and they may not keep them renewed. Some will even lie about having the certs. Most EMS owners have no idea that such certifications exist.

We have a training video you can watch to educate yourself about the EMS billing process. You will learn how to measure your biller's performance, and you will learn what you can rightfully demand from them. It is one hour long, and just covers all the basics -- just enough to give you a bird's-eye view of the process.

If you are at the mercy of a detached biller, protect yourself with this free education.

You can only monitor what they allow you to monitor

When all of your receivables are in somebody else's billing software, then you can only monitor the things they allow you to monitor. All those lovely reports in AngelTrack -- the reports you are paying for -- are useless.

Consequently, if your biller becomes irresponsible (either suddenly or gradually), you will not know until your cashflow is already in jeopardy.

Nobody sees it coming. One day you notice your bank account is low, and it will be difficult to make payroll. It will take a day of phone calls just to figure out where the problem is... and that is assuming your biller even takes your calls. You will spend the next week making infuriating discoveries such as:

We here in AngelTrack Support have seen all of those sins, when we have been called in for help in cleaning up after a detached biller goes bad. The problem is usually chronic by the time it's discovered. And the bottom line is always the same: much money lost, danger of insolvency.

Protect yourself by scrupulously entering all EOBs into AngelTrack. You have the right to demand them, and you have the right to receive them in electronic format (as X12.835 EDI documents) for quick import into AngelTrack. (If the phrase "X12.835 EDI document" is unfamiliar to you, read the EDI primer, and then you'll know how to talk the talk.)

Demand that the biller send you the past week's EOBs every week, without fail, so that you can spot problems sooner rather than later. AngelTrack will at least be able to tell you about denials and about stale calls, which are the two reliable warning signs of a biller going bad. Unfortunately, AngelTrack cannot tell you about ADRs, nor whether appeals are being filed in a timely manner.

Alternatives

Instead of allowing your biller to remain detached, you can demand they perform your billing in AngelTrack. Remember, they can access the system from their office, or from home, or from anywhere; they cannot use that as an excuse for not using the billing system you are paying for.

Nor does it cost anything. You can freely create user accounts for your biller's employees to use. It is all included in your AngelTrack license. So they cannot use cost as an excuse either.

Another alternative is to bring your billing in-house. As an AngelTrack customer, you already have a full-featured EMS billing system, including training materials. The billing process in AngelTrack is straightforward, and is designed specifically for EMS. If you watch the training video above, the last chapter of the video includes a walkthrough of the entire process.


All AngelTrack Queues are Serviced In-House

Before you deployed AngelTrack, there was someone in your organization who works with the outside biller, somebody who performs all of these tasks:

Whichever employee is shouldering this load will continue to do so, except now the tasks are mostly automated by AngelTrack. The software will reduce by about 90% the labor required to perform those tasks.

For this in-house employee, the biggest change will be adjusting to how AngelTrack organizes the work.

AngelTrack divides the aforementioned tasks up into queues. There is a queue for each task, and the queue contains all of the run tickets that are awaiting that task. For example, there is a queue containing all of the run tickets waiting to be sent to the outside biller. To learn about the different queues, read the Billing Queues guide.


Sending Reports Out to the Biller

Bulk export The Insurance Filing Queue is where you export the insurable run reports for transfer to the outside biller.

If you've done your reading and understand AngelTrack's queue system, then you know that the Insurance Filing Queue contains all dispatches that have passed QA and have been reviewed and approved for insurance filing. The only thing left to do is file them... and therefore this queue is the correct place to gather together all run reports that are headed to the outside biller.

The queue has a bulk exporter that can bundle up run reports in a .ZIP file. Each run report can be exported as a NEMSIS version 3 XML file (if your outside biller's software can import NEMSIS 3) or as a PDF file. Both formats include all attached documents, signatures, ECG strips, etc, and so either format is fully suitable for sending to an outside biller. Let the outside biller decide which format he or she prefers.

Exporting run reports as NEMSIS 3 XML files

NEMSIS 3 is the national standard format for exchange of EMS data between software applications... but many applications do not yet support it, or only support the obsolete version 2. AngelTrack supports version 3, which is the current version. Any insurance-filing application that supports NEMSIS version 3 will be able to bulk-import the run reports you exported from AngelTrack.

If your outside biller uses software that is NEMSIS 3 compliant, then it will save the massive amount of labor normally needed to type in your run reports. Instead they can be bulk imported, fully protected against typographical errors.

Don't forget step 2

Once you've downloaded the run reports from AngelTrack and sent them to the outside biller, you must tell AngelTrack that you've done so.

This is accomplished by recording a "Claim Filed" payment event for each dispatch. Payment events can be recorded one-by-one, or in bulk by clicking the relevant button next to the bulk exporter. (To learn more about payment events, refer to the Payment Events guide.)

When you record the "Claim Filed" events, the dispatches will be pushed forward to  Awaiting payment . If you manually push a dispatch forward but forget to record the event, then the dispatch will appear in the Special Handling Queue because AngelTrack is worried that an insurable call is set  Awaiting payment  when no insurance claim has been filed.


Processing EOBs Sent Back by the Biller

As EOBs come back from the outside biller, you must input them into AngelTrack as payment events. AngelTrack uses the payment event records to determine what is still owing, in order to automatically assemble your invoices for facilities, affiliates, and patients.

Ask your biller to send you EOBs in X12 835 format, which is the standard format for electronic EOBs. AngelTrack can import and process them automatically, saving you a great deal of data entry.

Importing electronic (X12.835) EOBs

Even though your biller is using a different piece of software, AngelTrack can match up the claims in the EOB to its own dispatch records by looking at the date of service, the patient name, and the modifier. It will then examine the claims in order to decide the next steps -- be it appeal, or be it invoicing. Read the Importing EOBs guide to learn more.

Importing paper EOBs

For each claim on a paper EOB, begin by locating its dispatch record:

Now the Payment Event Add page is open and waiting for data. For instructions on filling it out, read the Payment Event guide.

When recording any payment event, when you reach the "Next Steps" section at the bottom of the form, remember to pause and reflect. This is where you must consider whether to push the call back to  Billing office  for re-processing, or else to leave it  Awaiting payment  when there is nothing to do but wait, or perhaps give up and write it off (as  Finished ).

For example, if you receive a final denial, then you'll change the Payor to facility or to patient (depending on who is responsible), and then push the dispatch back to  Billing office  to be invoiced. Likewise, an approval with copay due should change the Payor to patient, and then go back to  Billing office  for invoicing. There are more examples in the Payment Event guide.

The detached biller probably handles appeals

Your outside biller probably handles insurance appeals, occasionally asking you for additional documentation. In that case you will not be recording any "Appealable Denial" payment events, and therefore nothing will ever appear in AngelTrack's Insurance Appeal Queue.

You will only tell AngelTrack about approvals and about final denials; in both cases, the dispatch then moves onward to invoicing (the facility or the patient).


Invoicing

A detached biller should not be delegated the task of invoicing your facilities and affiliates. (You might allow them to handle the patient invoices, though, to collect the copays; see below.)

AngelTrack's invoicing system provides bulletproof tracking of every receivable -- whether insurable or not -- to guarantee that every dispatch is paid in full. Perfect fidelity is maintained even when a customer requires many rounds of invoicing, or makes partial payments. AngelTrack's invoices are also decorated with invoice comments drawn from your billing and dispatch records, which greatly reduces the chance of a customer disputing their bill.

A detached biller is importing your receivable data into a foreign system and so cannot give the same guarantee or the same features.

You would also need to export everything to the detached biller, rather than just insurables: they will need your non-insurable run reports in order to compose a complete invoice.

If you wish to delegate invoicing to your outside biller, you should require them to integrate and use AngelTrack to do the invoices. There is no charge for doing so; simply create employee accounts for your biller's employees, and invite them to connect. They can then use AngelTrack's invoice generators, which are tightly integrated to the dispatch and QA review systems and are always aware of the state of every receivable.

Once your outside biller integrates, they can also perform other billing tasks that you may decide to assign. For example, they could handle your QA review for you; read the Outsourcing guide to learn more.

Outsourcing patient copay invoices

If you are confident of your detached biller's tracking system and trust their thoroughness, you can outsource the task of invoicing patients for copays.

When an EOB comes back showing insurance approval with copay due, leave the dispatch  Awaiting payment  instead of pushing it back to  Billing office  for invoicing. Wait for your detached biller to invoice the patient and, eventually, mail back the payment. When the payment arrives, record it in AngelTrack as an "approval" payment event from the patient, and then push the dispatch forward to  Finished .


Monitoring the Performance of a Detached Biller

It is inherently difficult to monitor a detached biller's activities and performance.

AngelTrack can provide assistance -- but only if someone in-house is uploading into AngelTrack all of the EOBs/ERAs that come back from the biller. Only then can the software help you track your revenues and denials, verify no receivables were overlooked, and prove (yay or nay) that your biller is doing their job right.

So, assuming your staff are dutifully recording everything sent to the biller and processing everything that comes back, AngelTrack has a very powerful report for monitoring your receivables: the Line Items Report, under Billing home. This report protects you from losing any receivables, because it combines your dispatch data and your billing data. If any dispatch has not been billed completely (or at all), it will be immediately obvious.

Many other useful reports for monitoring your biller are available under the "Receivables" and "Reports" sections of Billing home, including:

Remember, those reports only work if you are feeding EOBs from your biller back into AngelTrack.



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