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Account Matters Blog:

Stacey Fitzsimmons

Stacey Fitzsimmons
Stacey Fitzsimmons is the President and Chief Operating Officer of Account Matters. After years of PT, OT, and SLP Billing Consulting, Stacey decided to open Account Matters with her partner Diane McCutcheon. Stacey often writes for the Account Matters Billing Blog, sharing her expertise with private practice owners across the US so their business can be more profitable.
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Recent Posts

RCM Software is Only as Good as the People Using It

Posted by Stacey Fitzsimmons on September 17, 2019

Over the years I have had the privilege of using or at least viewing over a dozen different Medical billing software systems.  Some I liked, and some I did not.  Some were general medical software’s and some specific to Rehab Therapy.  As good or as bad as I thought a system was, not one of them could actually make more revenue for a company.

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Topics: Billing, Front Desk

3 Questions for your Biller

Posted by Stacey Fitzsimmons on August 9, 2018

Whether you outsource your billing or have a biller in your office you should be able to ask questions that keep you in control of your company at all times.  I have been in this business for years have heard many excuses about not being able to get what you are looking for out of your system and most of them are just simply not true. 

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Topics: Billing

Data Entry and Clean Claims

Posted by Stacey Fitzsimmons on July 18, 2018

As a billing company we estimate that at least 80% of the denials we see can be traced back to data entry/accuracy errors.  These errors occur on all types of insurance claims. 

Here are some examples:

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Topics: Billing, Front Desk

What is a Clearinghouse?

Posted by Stacey Fitzsimmons on July 18, 2018

Many providers do not know what a clearinghouse is or how it works.   Here is a breakdown of what a clearinghouse is and how it plays a major part in the billing process.

In medical billing, companies that function as intermediaries who forward claim information from healthcare providers to insurance payers are known as clearinghouses. In what is called claims scrubbing, clearinghouses check the claim for errors and verify that it is compatible with the payer software.  So, in other words a clearinghouse serves as a middleman; for your claims to get sent from the billing software to the insurance companies electronically.

Once the insurance company has received the claim from the clearinghouse they can process the claim.  The claim will either process for payment or process denied for any number of reasons.    

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Topics: Billing

Are You Submitting the Patient Summary Form?

Posted by Stacey Fitzsimmons on July 18, 2018
There is growing proof that medical providers are not up to date on why and when they should submit the mandatory Optum/United Healthcare  Patient Summary Form .  Here at Account Matters we are hearing first hand from clinics who are being denied payment because they are failing to submit this mandatory paperwork with UHC when required. 

Here is what you need to know:

The  Patient Summary Form  was created for certain UHC plans to provide the insurance company with an explanation for the patient’s visit and confirm the need for treatment.  The Patient Summary Form must be submitted via fax or on-line and the timely filing deadline for providing this documentation is  10  days from the date of service.

Failure to timely submit the  Patient Summary Form  will result in loss of payment.  If the claim is denied, an appeal may be filed but payment will only be received from UHC if you provide an “acceptable” explanation; leaving the chances of payment solely up to UHC’s discretion. 

There are two options you can use to determine if the patient has a plan with benefits that require a Patient Summary Form.  You can either call Optum Health Care Solutions at 1-888-329-5182 or log onto  www.myoptumhealthphysicalhealth.com  and use the “quick group check” utility located in the "Tools and Resources" section.

It doesn’t take long to check and submitting the form in a timely manner will ensure payment and eliminate the hassle of having to file an appeal.  We hope this helps you “ Get Paid Right the First Time ”.

If you have a billing problem you need solved, let us know at 508-422-0233.  We can help!
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Topics: Billing

3 Ways to Improve Patient Collections

Posted by Stacey Fitzsimmons on July 16, 2018

After years of consulting and billing, one of the hottest issues is how to improve patient collections. The responsibility of collecting patient payments is a front desk requirement.  While some are great at collecting at time of service, too many find it difficult to ask for money and many do not try, even though they know the payment is the patient’s obligation.

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Topics: Billing

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