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Medical billing,
end to end.
We understand the process of entrusting a billing company can be daunting. We are dedicated to a high standard of quality, professionalism and service in order to assist our clients in achieving their goals and values.
What you get
- Specialized billing teams — staff who work treatment-center claims, VOBs and UR every day.
- A dedicated biller for each facility — a personalized approach to your account, not a ticket queue.
- Verification of benefits seven days a week — including after hours and holidays.
- PHI handled with care — secure workflows built around the information you send us.
Verification of benefits
Our Verification of Benefit specialists understand that good billing begins with this step, and are trained in assessing benefit eligibility promptly. Clients receive a detailed electronic report including coverage details, eligibility, pertinent restrictions, authorizations needed, and recommendations from our conversation with the insurance representative. Electronic reports include deductible, coinsurance and copay information for every level of care, and are typically returned within 24 hours — weekends, after hours and holidays included. Turnaround depends on payer response times.
Pre-certification & utilization review
We employ experienced Utilization Review Specialists to assist your clinical team and treatment facility with patients’ insurance benefits. Our specialists help your staff document the information needed to show the patient meets the level of care you are billing for. Information is relayed to us through your electronic medical record, and our Utilization Specialists advocate for the days and sessions requested so your clinicians can stay focused on treatment. They update you promptly on clinical information needed and on the outcome of concurrent reviews. Clinical determinations, medical-necessity documentation and level-of-care decisions remain with your licensed clinicians. Our specialists prepare, submit and advocate; they do not practice.
Billing, coding & processing claims
Submitting the correct claim is what gets you paid for your services. We place heavy emphasis on processing claims within 72 hours. Every claim submitted is followed up with a status audit every week, and the status of every claim is relayed to you in a comprehensive weekly charge report. Through this diligence we safeguard your facility from confusion over receipt of payment, and can promptly begin the appeal process if any claim has been denied.
Recovery service
Insurance companies know healthcare providers are busy taking care of more important things — their patients. We address the details of each denial, and claims less than two years old are audited and, where there is a valid basis to appeal, appealed. We check for incorrect and incomplete claim filing while checking allowed amounts and NCCI (National Correct Coding Initiative) edits. Patient invoices and calls are generated on any past due co-pays, coinsurance or deductibles.
Aging reports
We produce an accounts-receivable aging report showing outstanding claims by payer and by age bucket, alongside the weekly charge report, and we update claim status on a regular basis.
Patient invoicing
We staff experienced people who can manage patient invoices and calls, including older co-pays, coinsurance and deductibles.
Credentialing & contracting
Medical credentialing is the process of verifying a provider’s qualifications — education, training, licensure, work history and malpractice history — so that payers and facilities can enroll and contract with them. Licensure itself is issued by state licensing boards; we do not obtain licenses. We handle the paperwork and the follow-up to get your facility and providers in network.
CRM & marketing support
Fully integrated CRM solutions for treatment centers — intake capture, follow-up automation and reporting, set up around how your admissions team actually works.
Lab pickup services
For treatment centers that conduct weekly drug tests, SMART provides pickup lab services on a scheduled route, so specimens leave your facility on a routine you can plan around.
Your dashboard
We’ve created a dashboard customized for each individual facility. It gives transparency into claims billed, payments received, outstanding balances, utilization reviews completed, daily/weekly/monthly census reports, and an interactive verification of benefits form. This cloud-based software hosts full-service revenue cycle management with reporting features updated daily.
New facilities
You’re building a new treatment center — don’t build billing headaches too. Smart MB provides a full billing department without the overhead. From day one you have a dedicated biller ready to go, seven-day-a-week VOBs, credentialing support to get you in network, and live dashboards to track collections in real time. And we only get paid when you get paid.
Centers moving from another billing company
Moving from another billing company? What we do differently is procedural: we work claims daily rather than in weekly batches, we report live, we cover VOB and authorization after hours, and you work with a team of specialists rather than a single contact person.
Centers billing in-house
In-house billing sounds good until it costs you. In-house billing means carrying the cost of keeping up with changing payer requirements, unpaid-claim follow-up, weekend verifications, denials and real-time reporting. With SMART there are no salaries, benefits or training costs — you get an experienced billing team plus UR, VOB and credentialing. We’re accountable, because we only earn when you do.
Revenue cycle management
Revenue cycle management is the process used by healthcare systems to track revenue from patients, from their initial appointment or encounter with the healthcare system to their final payment of balance. It covers all administrative and clinical functions that contribute to the capture, management and collection of patient service revenue — the life cycle of a patient through a healthcare encounter, from admission and registration through to final payment or adjustment off of accounts receivable.
Ancillary services
- CRM & marketing support — fully integrated CRM for treatment centers.
- Lab pickup services — pickup for centers running weekly drug tests.
- Referral program — introduce another facility, credit your invoice.
- Smart Reps — introduce a treatment center to our billing service and earn a commission on the account.
Medical billing FAQ
01 Does Smart offer consulting services?
Yes, we offer consulting services tailored specially for your practice. We also offer personalized data analytics of your practice economics as part of our Medical Billing services.
02 Can patients pay their bills using credit cards?
Yes, we do accept Credit Card payments from Patients.
03 Who receives the payments?
Your office receives payments directly from the payer. Payment timing is set by each payer, not by us. For Medicare, federal law sets a 14-day floor before a clean electronic claim can be paid (42 U.S.C. §1395u(c)(2)(B)); commercial payer timelines vary.
04 Do I need any special software or system for you to do our billing?
No. Whether you already have software or if you are not computerized at all, we can handle your billing. No computer is needed.
05 How do you charge for your services?
Our fee is based on the percentage of the revenue you collected as a result of our service throughout the month.
06 Will I get a dedicated team for my billing?
Each client is assigned a designated Account Manager, giving the security and comfort of working with a representative who is uniquely familiar with your practice.
07 How long does it take to get started with SMART?
We can start billing most insurance carriers immediately. Medicare and Medicaid/Medi-Cal require special authorization and it usually takes 2-3 weeks before we can submit claims on your behalf.
08 What information does our office need to provide SMART?
We need your patient’s demographics and insurance information, super-bills or charge sheets, and any EOBs that come to your office for posting purposes.
09 How often should we send our new billing to SMART?
We recommend that you send it daily or weekly to ensure consistent cash flow.
10 How will you handle billing our patients?
We will bill your patients for any balance due. Your patients receive a comprehensive statement carrying our telephone number, so billing questions come to us rather than to your staff.
11 How do you handle denials from insurance carriers?
We will review the denial to verify validity. If the denial is not valid we will appeal and resubmit the claim at no additional charge to the provider.
12 How often do you follow up on claims?
We follow up on claims as soon as the payer’s established reimbursement time frame has passed.