OPHTHALMOLOGY BILLING QUOTE REQUEST From MedicalBillingSelect — https://medicalbillingselect.com/ophthalmology-billing-services/ How to use this: fill in the brackets, then send the same email to every company you are considering. Same numbers, same list of work. That is what makes the answers comparable. Do not include patient names or records. ------------------------------------------------------------ Subject: Ophthalmology billing quote request — please price this scenario Hello, We are comparing billing companies for our eye practice. Please reply by email and price the scenario below. If you assume anything, or leave anything out, please say so. ABOUT OUR PRACTICE - State(s) and number of locations: [fill in] - Doctors and other clinicians: [fill in] - What we do: [general ophthalmology / retina / cataract or other surgery / glaucoma / oculoplastics / pediatrics] - We also have: [optical shop / surgery center we own / neither] - Insurance we bill most: [list medical plans and any vision plans] - EHR, practice management system, and clearinghouse: [names and versions] - Help we want: [all billing / selected tasks / oversight of our own biller] - When we want to start, and the notice we owe our current company: [fill in] PRICE THIS SAME MONTH FOR US - Money we collect in a month, drugs left out: $[amount] - Drug payments we collect in a month: $[amount] - Of the non-drug monthly collections above, $[amount] is collected by our own staff for [premium lens upgrades / cosmetic or refractive procedures / optical sales / other]. This amount is already included in the non-drug total, not additional. - Old unpaid claims we want worked: [rough total and age; keep any separately priced recoveries out of the ongoing collection figures above] YOUR FEE 1. What is your fee, and what exactly is it a percentage of? 2. Does the percentage apply to drug payments? If yes, will you leave drugs out, charge a lower rate on them, or charge a flat fee per drug claim? 3. Does the percentage apply to money our own staff collects: premium lens upgrades, cosmetic or refractive procedures, optical sales, copays at the desk? 4. Is there a monthly minimum? What else do you charge for: setup, software, clearinghouse, patient statements, reports? 5. When an insurer takes money back, do you return your fee on that money? 6. Please show the monthly bill and the first-year total for the scenario above, including any separate old-claims charge and the recovery assumption it uses. THE WORK For each item, please mark it: included / costs extra / stays with our staff / not offered. 7. Checking coverage and getting prior approval before injections and surgery 8. Tracking payer step-therapy requirements and handling authorization or exception paperwork with our clinicians; treatment decisions stay with them 9. Checking the drug code, units, and waste reporting on every drug claim before it goes out 10. A monthly reconciliation of drug inventory, administered doses, and documented waste with claims and payments, with unexplained differences and unpaid claims listed 11. Coding review and charge entry 12. Claim submission and payment posting 13. Denials, underpayments, and appeals 14. Shared post-surgery care with outside optometrists or other clinicians, including transfer documentation and who bills which services 15. Vision plan claims 16. Surgery center facility claims 17. Patient statements and patient phone calls 18. Old unpaid claims (and the price) 19. Insurance enrollment and credentialing PROOF YOU KNOW EYE CARE 20. How many eye practices do you bill today? How many are in our subspecialty? May we contact two of them? 21. Who would work our account, how long have they billed eye care, and where are they located? 22. Using made-up data, show us how you review a claim where an exam and an injection happen the same day. SOFTWARE AND REPORTS 23. Will you work inside our current system? Do you have a client on the same system today? 24. Please send a sample monthly report with made-up data. We want to see new claims, rejections, denials, payments, unpaid balances by age, and drug claims shown separately. 25. Can we see the status of every claim ourselves, at any time? CONTRACT AND LEAVING 26. What are the term, the renewal rule, the notice to cancel, and any exit charge? 27. If we leave: who finishes the open claims, who charges for payments received after the handoff, and how do we get our full data? Specify the export format, timing, any fee, and continued access during the handoff. Are the clearinghouse and electronic payment enrollments in our practice's name? 28. Please attach your business associate agreement. This request contains business numbers only. We will arrange the required business associate agreement and appropriate access before sharing patient information. Thank you, [Name, title, practice, email] ------------------------------------------------------------ General comparison information from MedicalBillingSelect. Not legal, coding, or financial advice.