OptiMED’s services range from initial setup to ongoing billing, maintenance, training, reporting, and more. Click for more information on:

Initial Setup Coding analysis Electronic billing & claims Paper claims Claims tracking & appeals Pending & denied claims follow-up Patient billing statements & soft collections Patient billing inquiries Payments & posting

Insurance verification & eligibility Office integration Credentialing documentation (in-network provider) HIPAA compliance Custom reporting Coding audits Ongoing communication & training Batch control Forms creation

Complete initial setup: Our service representative will provide a comprehensive study with physicians and office management to address all concerns about current practice management processes in place. Prior to launch, we will first fully integrate a practice computer system with OptiMED’s to ensure a seamless transition and simulate daily workflow. We will fully train your front office staff on proper procedures necessary for reimbursement. Part of the process includes a review and design of encounter forms (superbill) and much more. Our attention to detail and ease with which we communicate to your staff means a simpler transition of your billing management functions. ^ top

Coding analysis: OptiMED can review all superbills for ICD-9 & CPT-4 coding accuracy. Our AAPC Certified Professional Coders (CPC) have the skills and knowledge to ensure compliance with both the 1995 and 1997 E/M coding guidelines as well as inpatient and outpatient procedure codes set forth by CMS. In other words, we implement a system with cleaner claims for a faster turnaround. ^ top

Electronic billing & secondary, tertiary claims: Once OptiMED manages the billing cycle, all claims are reviewed, scrubbed and clearinghouse inspected within 48 hours of receipt. OptiMED then submits claims electronically to over 1350 accepting insurance companies, including Medicare, Medicaid, BC/BS, United Healthcare, Aetna and many more. Secondary claims are electronically “crossed over” where available. Carrier specific, electronic reimbursement averages between 7-14 days. ^ top

Paper claims: OptiMED will submit paper claims on standard CMS-1500 forms where detailed/complex billing and secondary/tertiary billing is not accepted electronically. Our certified coders are adept at handling complex issues.
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Claims tracking & appeals: OptiMED’s use of industry leading AdvancedMD’s software systems allows us to quickly flag denied and unpaid claims. Our system notifies our reimbursement specialists of any unpaid batches or individual claims, which are then handled with aggressive follow-up. This process ensures that nothing goes unpaid or unnoticed regardless of the amount or time that has elapsed. Continuous, aggressive monitoring of aged accounts is one of the key factors that separates OptiMED from our competitors—and results in higher revenues for your practice. ^ top

Aggressive follow-up on pending & denied claims: At OptiMED, our skilled and experienced reimbursement specialists are equipped to precisely determine what corrective action is necessary and appropriate to resubmit or appeal denied claims in a timely manner. And our extensive reporting capabilities are always available for your review. Aging reports, procedure analysis reports, and summary reports are just a sample of the hundreds of up-to-date reports available to you and your staff. ^ top

Patient billing statements & soft collections: OptiMED will bill patients for uncollected co-pays and balances due according to their insurance coverage policies. We will send four professional patient statements at 30, 60, 90, and 120 days. Our representatives will begin patient telephone calls starting at 45 days to encourage timely payments. On your behalf, we will arrange payment plans with patients when necessary. OptiMED will discuss policies and decisions with physicians or the designated office manager and will work with any collection agencies when applicable. ^ top

Patient billing inquiries: Our experienced staff can directly handle all patient inquiries and quickly provide correct information, optimally freeing your office to focus on patient care. ^ top

Payments & posting: To increase productivity and decrease the time it takes for you to receive insurance payments, OptiMED uses both electronic remittance advice (ERA) and electronic funds transfer (EFT) services, where available. This funds transfer technology frees time that allows us to focus more on complex denials and appeals that otherwise might not get the extra attention needed.
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Real-time insurance verification & eligibility: Both your practice and OptiMED will be equipped with simultaneous real-time patient verification and eligibility access. This technology ensures that your office and ours will have the most current policy/benefit information available upon check-in, including deductibles & co-pays. ^ top

Office integration: OptiMED’s adaptation of the latest web-based software allows us to seamlessly integrate our systems with yours. Both your office and ours will have real-time, secure access to all practice management information. By integrating systems in an online environment, it becomes easier to manage multiple offices, computer systems, and appointment schedulers. This Application Service Provider (ASP) model brings efficiencies, features, and security not available in older, problem-prone systems used by most billing centers today. ^ top

Credentialing documentation: As a no-cost, added value service to you, our staff will prepare provider applications for all insurance companies with whom you choose to participate. This service includes gathering all pertinent information and documentation needed for a successful application. OptiMED will monitor this process until you are an “In Network” provider. ^ top

HIPAA compliance: OptiMED endorses and is committed to all HIPAA privacy rules and regulations. Our solutions establish an environment that promotes high standards in legal and ethical behavior. We monitor continuously changing federal laws to keep our business associates ahead in an evolving healthcare environment. OptiMED’s clients are secure with the knowledge that we have implemented a strict Code of Conduct and Compliance Plan and that all staff members are committed to the highest business ethics. We strictly adhere to regulations governing third party billing centers as set forth by the Office of Inspector General of Health and Human Services. ^ top

Custom reporting: Reports are vital to managing a successful practice and planning for the future. Accurately measuring your practice’s financial health is essential in today’s healthcare industry. OptiMED provides fully customized, real-time, weekly and monthly reports which allow decision makers to fully evaluate practice management. Our reporting capabilities provide incisive data necessary for informed, knowledgeable decisions. ^ top

Coding audits: Accurate coding is key when it comes to complying with government regulations and optimizing revenue—even on a daily basis. OptiMED offers coding audit services which will provide your practice with valuable information such as:

• Identifying potential areas of lost revenue due to undercoding;
• Ensuring adherence to CMS 1995 or 1997 coding and documentation guidelines; and
• Optimizing reimbursement and compliance through continuous evaluation. ^ top

Ongoing communication & training: OptiMED is determined to help position your practice for current and future success. With success in mind, we continuously address all physician and staff concerns and update personnel on changing reimbursement legislation and coding requirements. ^ top

Total batch control: To ensure fast, easy tracking and claims accountability, all claims are batched and recorded to each reimbursement specialist. This means your claims receive consistent, personal attention. ^ top

Forms creation: OptiMED can customize your Superbills, Patient Registration Forms, and Authorization for Release Forms for your practice’s specific needs.
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Call today to set up a free initial consultation:

Sarasota (941) 927-2245
Boston (617) 803-7941