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What to expect, 3 of 7Read this when you have a billing start date, or when your first payer approves.

Billing is starting. What to expect.

The start date, EHR access, direct deposit setup, the first claims and the first invoice, what stays yours, and what surprises people in month one.

Before the start date

Billing starts on a date, not at signing. Pick one at least a week after you give us EHR access so we can look around first.

  1. 1

    Add Bomi as a billing user in your EHR

    Use the practice-specific billing address from your welcome email (billing+yourpractice@billwithbomi.com). SimplePractice: a team member with the Biller role, which needs the Plus tier. TherapyNotes: a Practice Biller account. Sessions Health and TheraNest: a team member with billing access. Bomi EHR: nothing to add. Give us the billing role only; it shows us your schedule, insurance details, and billing, and we do not need or read your notes.

  2. 2

    We set up direct deposit and ERAs with each payer

    EFT so payments land in your bank account instead of the mailbox, and ERA so each payment’s details flow back into your EHR and post automatically. Some payers enroll through their own portals (Optum, Availity, Zelis, ECHO) and some take a couple of weeks; BCBS is often about 15 business days. We opt you out of fee-charging virtual cards wherever a payer offers them.

  3. 3

    We load payers and check your clients

    Payer IDs go into the EHR. We check that each insurance client has a card on file, a current insurance card, date of birth, and address, and we verify benefits for everyone on the next two weeks of your schedule. Anyone out of network or inactive gets flagged to you before their session.

  4. 4

    You tell us the house rules

    Sliding-scale clients, payment plans, anyone whose card should never be charged automatically, how you want credits handled, and whether old balances from before the start date are in scope. We follow what you tell us; we do not guess.

A session, start to finish

  • Two weeks before

    What happens: Benefits verified: network status, copay, deductible, visit limits. Automated check first, then a call when it is unclear.

    Who: Bomi

  • The session

    What happens: You hold it, set the appointment status (completed, no-show, late cancel), make sure the code and rate are right by end of day, and sign your note.

    Who: You

  • Next morning

    What happens: Claim submitted and the copay charged to the card on file. Not same-day, so you have the evening to fix a code.

    Who: Bomi

  • About 4 days (median)

    What happens: Payer pays your practice by direct deposit. That is the median on Bomi-billed claims; Medicare pays electronic claims no earlier than day 14, and some payers take a few weeks. The ERA posts the payment in your EHR.

    Who: Payer

  • When the EOB differs

    What happens: If the payer says the copay or deductible was different from the estimate, we adjust: a small difference is charged or credited, a large one we ask you about first.

    Who: Bomi

  • If it does not pay

    What happens: Denials and rejections worked within 1 to 2 days. Claims still sitting unpaid chased at 14 to 30 days depending on the payer. Reprocessing at a payer typically takes 30 to 45 business days.

    Who: Bomi

  • Every Monday

    What happens: One email: credentialing updates, what we are chasing, balances and credits, and what needs you.

    Who: Bomi

What stays yours, what is ours

You

  • Correct CPT code, modifier, and rate on each session by end of the day
  • Signed notes, in your own EHR
  • Appointment status: completed, no-show, late cancel
  • Recording payments clients hand you in cash or by check (we cannot see them otherwise)
  • Uploading a new insurance card when a client hands you one
  • Conversations with clients about balances, declined cards, and payment plans
  • Forwarding anything a payer mails or emails you

Bomi

  • Benefit checks before sessions, and a copy-paste quote for the client when you ask
  • Claims the next morning; secondary claims once the primary has processed
  • Charging copays and no-show or late-cancel fees to the card on file
  • Posting payments and reading every EOB and ERA
  • Denials, rejections, stale claims, reprocessing, and the phone calls
  • Direct deposit and ERA enrollment with every payer
  • CAQH, attestations, rosters, and re-credentialing
  • The Monday email and the portal

What we never do

  • Contact your clients. If a card declines or coverage lapses, we tell you and you talk to them.
  • Hold your money. Payers deposit directly into your account and client cards run through your own processor; we invoice our fee separately.
  • Send anyone to collections. We keep balances small by catching them early; we do not chase clients.
  • Read your clinical notes.

Money: the first invoice

  1. 1

    Early next month, one invoice

    Around the 1st to the 5th, we add up the payments that landed in your account during the month for sessions on or after your start date (insurance payments, copays, and self-pay) and invoice 4% of it. Claims still pending are not counted. Pay by bank transfer or card through the invoice link.

  2. 2

    Only from the start date

    Payments for sessions before your start date are not in the fee, even if they arrive after it. Neither is anything a platform like Headway or Alma pays you directly.

  3. 3

    If the first month is not a fit

    Tell us before the first invoice and we will not charge the billing fee for that month. After that, it is month to month with 30 days’ notice.

Things that surprise people in month one

A paper check or a debit card showed up from an insurer.
Direct deposit enrollment takes a few weeks with some payers, so checks keep coming for a while. Deposit it and forward us the EOB that came with it (and the check number); we post it against the right clients. Do not enter it yourself or it gets posted twice. Virtual debit cards charge a fee; do not activate one, forward it and we will get the payer to re-issue.
The copay we charged does not match the EOB.
A benefit check is an estimate. Ours match the final claim about 93% of the time; deductibles are the usual miss, especially in January when they reset. When the EOB disagrees, we fix the ledger: a small difference gets charged or credited within the card-on-file agreement, a large one comes to you in the Monday email first.
A claim denied for "coverage inactive" or "coordination of benefits".
The two most common first-month denials. Usually the client has new insurance or a secondary plan the primary does not know about. We tell you what to ask the client for (a new card, or a call to their insurer about COB); you ask; we resubmit.
We quoted the client one amount and the first session paid differently.
A first session is usually billed as a diagnostic evaluation (90791), which most plans pay differently from an ongoing session (90837 or 90834). Quotes default to the ongoing session; ask and we quote both.
A client has a balance and I do not know why.
The Monday email annotates every balance: declined card, deductible not met, benefit estimate off, no card on file. Under about $50 we usually just charge the card. Larger, or anything sensitive, we ask you what you want to do.
The same client has a credit.
A payer paid more than estimated, or a card was charged before the EOB came back. By default we apply credits to the next session; tell us if you would rather refund.
A secondary claim is taking forever.
A secondary claim goes out after the primary has processed the claim, even if the primary paid $0, because the secondary needs the primary’s explanation. Expect it to lag the primary by a few weeks. It shows up under On our radar until it pays.
A payer asked for records or a prior authorization.
Records: we tell you what they want and the deadline; you send them, since we do not access notes. Prior authorizations: where a payer requires one we request it, and may need clinical details from you. Authorizations and visit limits are tracked in the portal so neither of us is surprised.

Changing billers

If someone else is billing for you today, the handoff is a date and a list.

  1. 1

    Pick a handoff date

    Usually the first of a month, at least a week after we have EHR access. Sessions on or after that date are billed by us; sessions before it were billed by them. Tell your current biller the date; we prefer not to coordinate with them directly.

  2. 2

    Share the open-claims list

    Even though they billed them, we follow up by default on claims your previous biller submitted in the month before the handoff, so nothing falls between us. Further back is fine if you ask; tell us which clients or payers.

  3. 3

    Expect a 30 to 45 day overlap

    Their last claims pay out while our first ones go in. The Monday email separates the two so you can see what each of us is responsible for. Old balances and credits from before the handoff are only in scope if you ask us to work them.

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