Contractual Terms

All Acubiller clients sign our standard contract, which stipulates the following:

 

Acubiller will submit medical billings for reimbursement on ​Client​’s behalf, check patient benefits, and follow up on claims as needed.

 

Acubiller is HIPAA-compliant, and will safeguard the privacy of clients and their patients.​ Client understands that claims will be submitted via electronic media and, as such, will be responsible for notifying clients of their HIPAA rights concerning online submission and email.

 

Client​ agrees to the following:

 

• All information provided to Acubiller is true and accurate to ​Client​’s best knowledge.
• Client​ will hold Acubiller harmless from all claims, liabilities, costs, and expenses arising from breach by ​Client​ of any applicable law or regulation.
• Client​ will submit all of their insurance claims through Acubiller (unless a prior arrangement has been agree to by both parties)
• Client​ agrees to notify Acubiller ​immediately​ regarding changes to practice address,practice name, billing address, provider name, and tax ID, and to update through Acubiller/Alchemy Credentialing.
• Acubiller will invoice​ Client at the beginning of each month. Payment is due by the 20th of the month (within 19 days). Otherwise, Acubiller services will cease until outstanding payments are settled.
• Client​ agrees to pay all setup and monthly fees as outlined in the fee schedule.

 

The Basics

As an Acubiller client, you may not:

 

• File your own claims. ALL of your insurance claims, whether in- or out-of-network, whether health insurance, WC, MVA, PIP, VA, etc - must be filed through Acubiller.
• Move, or update your demographic information, without notifying Acubiller. ALL updates must be carefully coordinated via our update department (and our sister company Alchemy Credentialing when applicable).
• Refuse to follow our standard procedures. Our administrative processes ensure a high degree of quality control. These measures ensure our efficiency as a company. Clients are not entitled to reject our quality control measures.
• Evade signup fees or withhold bill payments. Once signed, our contract is binding.

 

Additionally, please do not...

 

• Unsubscribe from our newsletter lists. We send monthly invoices and important notices via Mailchimp.
• Delay submission of claims unduly. It compromises the quality of carrier benefit reporting, which affects patients and other providers, and significantly increases the risk of nonpayment.

 

These Practices Will Get You Audited

• Misuse of corrected claims. If claims do not pay because you billed unacceptable diagnoses or procedures, you may not alter coding until the carrier pays. "Fudging" your billing is insurance fraud. Corrected claims are meant for administrative errors ONLY.
• Billing an exam (i.e. E/M codes) on every date of service. Some evaluation is implicit for acupuncture procedure codes 97810 thru 97814. It is not appropriate to bill that eval separately on every DOS. Bill exam codes on the patient's first visit with you, then every 5-6 visits, or when the patient presents a new diagnosis.
• Billing too many units per claim ("Overbilling"). Most major carriers will entertain up to 4 units per DOS. Our most successful clients bill 1-3 units per DOS and under an hour of time. Billing 7-8 units per DOS results in a high instance of claim denial. Clients who overbill request followup (FUP) more than any other segment of our client base, which is ultimately a poor use of our departmental resources. Overbilling attracts a great deal of unwanted scrutiny from insurance carriers. The biggest mistake you can make is becoming dangerously reliant on the unwarranted cash flow overbilling may have brought you in the past.
• Overcharging. If you price your services too highly in order to maximize insurance payouts, carriers are obligated to investigate potential fraud and prevent financial exploitation of their customers. They may even send warning notices to your patients, effectively warning them to seek treatment with someone else.

 

We encourage our clients to bill conservatively. Avoid these four practices to minimize legal and financial risk to your clinic.