Frequently Asked Questions
What kind of accounts do you work? ie ER, REHAB, Wound Care, surgery:
- We handle everything that gets billed to an auto or WC claim.
- We have experience in the entire ER segment, including facility and doctor charges.
- We have Ambulances including one of the local municipalities who run their own emergency responder units.
- We handle wound care and surgery charges for our hospital as well.
- This is especially true for WC claims, which need a lot of claim rep attention, and many times have significant differences between what the hospital should be paid and what the WC carrier pays.
- Because we are “specialized” we deal with Ortho, Neuro, Diagnostic Testing Center, ER Docs, Urgent Care, Anesthesia and Hospitals (especially Trauma hospitals) with auto & WC claims more than other stuff.
- We do not handle any family medicine, GP, Dermatology, Cancer/Oncology, Cardiac, or other non-accident related specialties.
**** There are always a few miscellaneous charges that somehow jump into WC on occasion, but they are pretty rare. The bulk is trauma related charges
Do we identify potential MVA accounts on commercially paid accounts?
- The short answer is YES.
- We have handled commercial accounts which we move to PIP as the primary payer before we revert them back to the commercial payer. This is pretty commonplace in our billing effort. Some hospitals like us to only handle the PIP aspect of the claim, and they take back claim management after the PIP is completed for commercial and government payer coordination.
- We have also handled major league baseball/local hospital contracts, which are work comp in nature and that includes reviewing all claims for MVA and WC and TPL LOP collection. That is a big and difficult job for any billing staff and comes at a premium. It is pretty labor intensive
How do you handle denials or payment reduction for payment without attestation (meets Emergency criteria)?
- We handle all claims we are given through to the end if allowed to do so. Whether we are billing PIP or Work Comp we handle all reductions, denials, and improperly calculated reimbursements. Because fighting and appeals requires additional time and effort from the hospital, to best execute this plan we prefer to have an employee in the hospital who works for both companies. This joint employee helps us maximize the claims and overcome denials.
How do you handle payment reduction for payment without attestation (meets Emergency criteria)?
- We have developed a number of systems to circumvent this common denial. One great system rests in teaching your ER doctor group what to say in their medical note to help the hospital get paid. The EMTALA (the Emergency Medical Treatment and Labor Act) has a strict definition for EMC that is different then what it means in the PIP statute. This gives the ER doctors pause to call things EMCs when they don’t meet the EMTALA specifications, but they do meet the PIP specifications. We have met with ER groups and have trained them to start every auto accident specific claim note that is a NON-committal statement. This statement follows the law of the EMTALA or clearly articulate that the patient is suffering from an EMC. That simple statement opens the doors to $10,000 in PIP instead of $2500.
How do you identify/work claims where original visit was not here?
- We do a lot of digging and gathering of information from patients. We call employers & carriers and report claims for them. We go that extra step to get the claim filed with the right carrier. It isn’t full proof. Billing for hospitals is a volume game. But we pride ourselves on being both fast and good at the Sherlock Holmes game. That is why we want you to GO- “Specialized” Billing!
What type of access/data do you need?
- Not that much. Depending on the nature of the contract the more we do the more documentation we need. But “access” is a matter of speed and convenience for the client. We have a secured API interfaces for data transfers with many of our clients. If that is not workable we have secure box transfers.
- Day One Billing: We love getting the demographic client data as it comes through the hospital’s software (we have worked in a number of software systems including McKesson, Epic, Siemens, E-Clinical, etc.)
- Historical zero balance rebilling project: We simply need the HCFA/UB or billing ledger, and if possible, the Assignment of Benefits (AOB). We run a very fast rebilling project that brings in more than you expect.
- Our bottom line is we work within the comfort level of our clients. We do everything in a HIPAA complaint secure environment. For really behind the tech curve clients we even travel to our client’s facility with a secure zip drive and sit at our client’s computer workstation and download the documents they want us to access. It just depends on the client. We have had full access to Parrish billing systems in the past.
How many clients do you have & How many of these are in Florida & how many are acute care?
- We have a total of 57 clients. 51 in Florida and 6 facilities in Massachusetts.
How many years have you been in business?
- GOSB was founded in 2009. LaBovick started in revenue cycle management in 1999, handling PIP claims for local medical practices. His management team has an average of 20 years in hospital revenue cycle management between them.