Frequently Asked Questions
Frequently Asked Questions
FAQs about RevCycle Partners’ RCM Services for Optometry
We get it. Before you sign up for one of our services—Insurance Billing, WeCredential, or WeVerify—you will have some questions. We are happy to answer any of your questions over a call or by email. But you can get started getting some of your questions answered by digging into answers below. These are the most frequently asked questions about our RCM services for optometry.
Insurance Billing FAQs
RevCycle will scrub claims prior to submission. Some examples of things your biller will look at: adding necessary modifiers, diagnosis for medical necessity based on service code and payer, and cataract co-manage claims for surgeon information and billing details.
RevCycle will transfer necessary patient responsibility based on insurance processing: deductibles, co-insurance and copays. RevCycle will provide as much detail as possible using transfer reasons to describe why a transfer was done and why a patient may owe you money.
If a claim is denied, RevCycle Partners will investigate the denial and take the appropriate action. We will:• Fix the claim and resubmit. RevCycle Partners will file any appeals as needed, as long as we have the documentation to back it up.• Relay the denial back to the office for review/correction. RevCycle Partners will refile the corrected claim.• Drop the denial amount to the patient with a detailed transfer reason.
RevCycle Partners will exhaust all avenues available to get a claim paid, including filing appeals, chasing denials, and refiling claims.
With RevCycle Partners there is no long-term commitment. Our service is a month-to-month. You may cancel at any time. We ask for a 60-day termination notice so we can properly wind down the account and reallocate our resources.
Sometimes my staff forgets to add a procedure performed such as a visual field, is this something RevCycle Partners checks for?
No. That is the responsibility of the doctor or office to make sure all services that are performed are coded and applied to an invoice. RevCycle Partners asks that the office verify this as well as make sure that there is a diagnosis on the claim prior to authorizing it. RevCycle Partners will submit corrected claims if something was missed.
There is a relationship between the office and a patient that RevCycle Partners is not familiar with. Our team doesn’t want to risk causing any issues for the office or the patient. If the office has a question about a patient balance, they can send their biller a message and/or call. We are happy to provide further details to help explain why the balance is owed.
For items received in office, we ask that those be scanned to a designated area within your system for review by your biller. This can include EOBs, checks, and requests for records.
Sending patient statements is not included with RevCycle Partners’ billing service. That responsibility remains in-office.
RevCycle Partners does not upload EOBs into the EMR software. EOBs are accessible through the website when needed (or by calling the insurance to resend).
There are not any set-up or cancellation fees for RevCycle Partners’ billing services.
Does RevCycle Partners monitor to see if we are getting paid according to our contracts for maximum reimbursement?
RevCycle Partners does not ensure that max reimbursement was received. Max reimbursement/fee schedules are specific to each practice and their contract with the payer. RevCycle Partners does not have access to the fee schedules. We follow the EOB, and we will pull up previous processing to review the codes/payments if needed.
Do I need a clearinghouse to utilize your billing service? Does RevCycle Partners provide the clearinghouse?
A clearinghouse is required in order for us to provide our Medical Claims Management service to any practice. We are not a clearinghouse, nor do we supply the clearinghouse. Practices will need to be set up with a clearinghouse. That way, if the practice makes any changes to their billing services, nothing changes with their billing/workflow.
During onboarding, RevCycle Partners will request login access to the clearinghouse and any external payer portal websites so that we can retrieve electronic remits accordingly.
Our standard process is to access and work our accounts once daily, Monday-Friday. We will take care of any filing, payment posting, and denial follow-up on a daily basis.
Yes. RevCycle Partners requires a two-year agreement for its ongoing credentialing offering called “Maintenance Services.” The amount of maintenance work required each month can vary dramatically. Spreading the work and cost out over a 2-year contract creates balance for the practice and RevCycle Partners.
Payers that require contracting/credentialing are the ones that would be monitored under the Maintenance Service. Many practices also receive payments from life insurance, Medicare Advantage plans, or Third Party Administrators (TPAs), but those do not require contracting/credentialing. Credentialing with the Advantage Plans is included with the main payer, and revalidations would cover the Advantage Plans for the payer.
Unfortunately, RevCycle Partners cannot advise on which networks are open or closed. Networks can open and close at any time throughout the year. Networks can also be closed in small, very targeted areas. In many cases, the payer won’t indicate that a panel would be closed for a provider unless an application is submitted. In addition, a network may be closed for one provider and not another in the same area.
In network means the health care provider has contracted with an insurance plan and approved services are paid according to the contracted fee schedule. Out of network means the health care provider is not contracted with an insurance plan, and benefits will generally process under out of network benefits. This usually means higher out of pocket expenses for the patient.
It is the Council for Affordable Quality Healthcare. Yes, you must have a CAQH profile on file. A majority of the insurance companies use CAQH to confirm information that has been provided to them.
RevCycle Partners will verify and update information as required throughout the credentialing process. Having CAQH and PECOS access reduces paperwork and ensures timely receipt of information.
Depending on the reason for denial, RevCycle Partners will submit an appeal and/or request participation a second time, 3-6 months later.
Yes. RevCycle Partners has verified your information and completed and filed the necessary paperwork on your behalf. We cannot guarantee acceptance. That is solely up to the insurance company to determine.
No. For many insurances, being credentialed means you can see patients, but it will pay as out of network.
Credentialing is the process of establishing the qualifications of licensed medical professionals and assessing their background and legitimacy. Credentialing is required for most insurance companies to be contracted. Contracted means you are an in-network provider and have a signed agreement to accept patients for an agreed fee for service.
No. All contract negotiations and fee decisions are the responsibility of the practice.
RevCycle Partners will update information as it’s received from the insurance companies. You can login to your portal account to access any updates noted at any time. RevCycle Partners will provide updates at least once a month.
If the insurance reaches out to you or sends you any documentation, it is imperative that you notify a credentialing team member immediately. Failure to forward information from the insurance causes delays. It can also mean having to start the application process over.
The timeframe all depends on the payer. Some will complete applications in 30 to 60 days. Generally, you should expect the process to take up to 120 days, sometimes longer. We experienced significant delays on payer responses during Covid, and many payers have not caught up yet. Contracting can take an additional 60 days. There are variations in time depending on insurance and reasoning, it can mean shorter and/or longer time frames.
All doctors expecting to receive reassignment of benefits as a participating provider for claims, must be contracted with the insurance plan, and therefore require credentialing. The amount of time or hours the provider works is not applicable to this requirement.
If you are joining a practice within the same state, and you are already participating with payers, demographic updates will take care of linking you to your new practice.If you are joining a practice in a different state, full applications will apply.If you are purchasing or opening a new practice and are establishing a new NPI/Tax ID/company name, brand new credentialing will be required for the EIN, and you may need demographic updates to link yourself to the Group.RevCycle Partners will look to perform the credentialing project in the most efficient and cost-effective manner.
If you are opening a new practice, or if you are adding a new provider to your practice, the credentialing process can begin 60 days before the practice opens, or 60 days before the new provider starts.If the new hire is a new graduate, they will need their license, insurance, and CAQH set up before the credentialing process can begin.
There is no long-term commitment. You may cancel at any time. We ask for a 60-day termination notice so we can properly wind down the account and reallocate our resources.
We do not. We guarantee the schedule two days ahead of the visit. Any new appointment that falls within that 48-hour window would be the office’s responsibility.
While we can and do obtain benefits for out-of-network Medical plans, we are not able to obtain benefits for out-of-network Vision plans. On the Vision side, it is becoming harder to obtain benefits for OON payers. Many payers, like VSP, are directing users to have their patients contact the payer directly or send claims in for out-of-network services.
Yes, WeVerify will obtain the deductible and remaining deductible amounts.
The deductible is tallied based on who gets to the insurance first and applied in that order. We are given information based on the date and time asked. Things can be processed after and in-between. Offices that know their fee schedules can collect most accurately.
Yes, WeVerify will obtain authorizations from Vision Plans and upload them into the PMS for office use. WeVerify does not upload Medical documents into the PMS.
The service was built to provide all benefits for all of a patient’s plans. We feel the value of our service is allowing you the opportunity to utilize the benefits to the fullest. That said, if you have specific needs or concerns, we can schedule a conversation to determine whether a custom design would be favorable.
We do not obtain Medical referrals. If a Medical referral is required, WeVerify would notify the office that one is needed, and the office is responsible for obtaining it.
We do not check benefits for cataract post-ops. We do not check benefits for any post-op appointments because generally these appointments are following a recent exam and/or referral where the initial benefits are still valid.
If there is no insurance listed for the patient on the schedule, WeVerify will look for any family links for the patient to see if there is an insurance we can try to verify for Medical. For Vision payers, WeVerify will attempt to search for plan benefits by using the patient name and DOB.
Yes. If WeVerify attempts a verification and is unsuccessful in obtaining information, we will charge for the verification because we took the time and resources to try and verify the benefits.
Yes. WeVerify will store the benefit details we obtain in standard templates inside of the practice management system.