Billing questions
Medical Billing FAQ: Straight Answers for Practices
Straight answers on billing services, pricing models, payment timelines, credentialing and data security, for practice owners, managers and billers.
Medical billing FAQ for practice owners and billing teams
This medical billing FAQ answers the questions practice owners, office managers and billers ask most often, from how a billing company works to how long payers take and what credentialing involves. Answers are short and practical, and each one points to the page where the topic is covered in depth.
Payer rules change and differ by plan, so treat the timelines and rules here as a starting point. Check your payer contracts and the payer's own manuals for the details that apply to your practice. For a walkthrough of the full claim cycle, read the medical billing process guide.
Questions are grouped by topic: getting started, pricing and contracts, claims and payments, credentialing, security and compliance, and specialties and locations. If your question is not here, the contact page is the quickest route, and enquiries get a reply within one business day.
How a claim moves from visit to payment
Many of the questions below make more sense once you see the order of the work. Each step depends on the one before it, so an error early in the cycle usually shows up later as a rejection, a denial or a slow payment.
- Before the visit: verify eligibility and benefits, confirm whether prior authorization is needed and collect the copay.
- After the visit: the provider documents the service, and codes and modifiers are assigned from the note.
- Charge entry and claim scrubbing: charges are entered and checked against payer edits before submission.
- Submission: the claim goes to the payer, usually through a clearinghouse, and acknowledgment reports confirm it was accepted.
- Payment posting: ERAs and EOBs are posted, and underpayments or denials are flagged.
- Follow-up: denied or unpaid claims are corrected, appealed or escalated, and any patient balance is billed.
The denial management and AR follow-up steps are where many practices lose time, which is why they come up so often in the answers below.
Who handles what in an outsourced billing arrangement
Many questions about outsourcing come down to the split of responsibilities. The table shows a typical division when a practice works with a billing company. Your agreement should spell out each line.
| Task | Billing company | Practice |
|---|---|---|
| Eligibility and benefits checks | Verifies coverage, copays and authorization needs | Collects current insurance cards and demographics |
| Documentation and coding | Reviews codes and modifiers against the note, queries the provider | Documents the visit and signs the note |
| Claim submission | Scrubs and submits claims through your clearinghouse | Keeps the clearinghouse and payer enrollments in its name |
| Payments and denials | Posts ERAs and EOBs, works denials and appeals | Approves write-offs and refunds |
| Patient balances | Sends statements and handles billing questions | Sets financial policies and payment plan terms |
Fastora's medical billing services follow this split, with a dedicated account contact who coordinates anything that needs a decision from the practice.
Payment timelines at a glance
The question of how fast claims are paid comes up in almost every conversation. The rules below are set by regulators. Contracted payers may add their own terms, and plans that are exempt from state law follow their contracts.
| Payer type | Rule | Source |
|---|---|---|
| Medicare (clean claim) | Payment floor: earliest payment on day 14 (electronic) or day 29 (paper); interest owed if not paid within 30 days of receipt | Medicare contractor guidance |
| Medicare (filing deadline) | Claim due within 12 months of the date of service | 42 CFR 424.44 |
| Texas HMO and PPO plans (fully insured) | Clean electronic claims paid or denied within 30 days, paper within 45 days; providers file within 95 days of service | Texas Department of Insurance |
| Self-funded employer plans, Medicaid, Medicare Advantage | Not covered by Texas prompt pay; follow the plan's contract and program rules | Texas Department of Insurance |
Our articles on timely filing limits and the Texas Prompt Pay Act explain the rules and exceptions in more detail.
Checklist before you sign with any billing company
Use this checklist when comparing billing companies, including Fastora. Each item is a question you can ask in the first call.
- Which services are included, and which cost extra?
- What is the pricing model, and which payments count toward a percentage fee?
- Will the team work inside our EHR/PM system, and who owns the data?
- Is a Business Associate Agreement signed before PHI access?
- Who is our day-to-day contact, and how fast are enquiries answered?
- Which reports will we receive, and how often do we review them together?
- How are open claims and AR handled if the agreement ends?
A free billing assessment is the easiest way to get these answers for your own practice. It reviews your claims, denials and AR before you commit to anything.
If your question is about how claims are checked before submission, see how Fastora reviews claims before submission for the review steps we apply to every claim.
FAQ
Getting started
What does a medical billing company do?
A medical billing company turns your visits into payments. The work typically covers eligibility checks, coding review, claim scrubbing and submission, payment posting, denial work and appeals, AR follow-up and patient statements. Some companies, including Fastora, also handle prior authorization, credentialing and payer enrollment. The practice still owns clinical documentation, contracts and financial policies. The Medical Billing Services page lists the full scope.
How long does medical billing take to set up with a new company?
It depends on the number of providers, payers and locations, and whether anyone still needs credentialing. The main steps are signing a Business Associate Agreement, creating user access in your EHR, confirming clearinghouse and ERA enrollment, and agreeing on who handles open AR. Fastora starts with a free billing assessment, so the go-live plan is based on your actual setup rather than a generic timeline.
How long does medical billing take for a single claim?
There are two clocks. The first is internal: how quickly the visit is documented, coded and submitted, which a well-run practice keeps short and consistent. The second is the payer: processing time after the claim is received, which depends on the payer, the submission method and whether the claim is clean. Delays in either clock push out the date you are paid.
Do I have to change my EHR or practice management software?
No. Fastora works inside your existing EHR/PM system under user access you grant, with no software to install. Your data stays in your own account. Fastora is not affiliated with any software vendor, and compatibility and access are confirmed during onboarding. The EHR & PM Systems page explains how this works for common platforms.
What should I have ready for the free billing assessment?
Helpful items include recent AR aging reports, a denial or rejection summary, a sample of remittances, your payer mix and any payer contracts or fee schedules you want reviewed. Do not send patient information through the website contact form. Fastora signs a Business Associate Agreement and sets up a secure channel before any protected health information is shared. See the Free Medical Billing Audit page.
Can I outsource only part of my billing?
Yes. Many practices start with back-end work such as denial management and AR follow-up, then add front-end tasks like eligibility verification and prior authorization later. Others outsource only old AR cleanup or credentialing. You choose the scope, and the agreement lists which tasks Fastora handles and which stay with your staff, so nothing falls between the two teams.
Pricing & contracts
How do medical billing companies get paid?
Most use one of three models: a percentage of collections, a flat fee per claim, or a hybrid that combines a base fee with a percentage or per-claim charge. Some charge separately for one-time projects such as old AR cleanup or credentialing. Ask which collections count toward a percentage fee, and whether patient payments and refunds are included. The Pricing page explains Fastora's approach.
How much does Fastora charge?
Fastora quotes after the free billing assessment, once the scope, specialty, claim volume and payer mix are clear. Depending on the work, pricing may be a percentage of collections, a flat fee per claim or a hybrid. There are no hidden setup fees. The Pricing page and the article on medical billing services cost explain how each model works.
Are there setup fees or software costs?
Fastora has no hidden setup fees and no software to install, because the team works inside the EHR/PM system you already use. Your existing software and clearinghouse subscriptions stay with you, so check those contracts separately. Any one-time project, such as a large legacy AR cleanup, would be discussed and agreed in writing before work starts.
What should a medical billing contract include?
Look for a clear list of included services, the pricing basis and what counts as collections, reporting commitments, data ownership, a Business Associate Agreement, termination terms and how open claims are handled at the end. Also check who has access to your EHR and clearinghouse. The article How to Choose a Medical Billing Company includes a checklist of contract questions.
What happens to my data and open claims if I leave?
Because Fastora works inside your own EHR/PM account, your claims, notes and payment history never leave your system. When an engagement ends, user access is removed and open work is handed back according to the agreement. The article on how to switch medical billing companies covers the transition steps, including AR ownership and clearinghouse settings.
Claims & payments
How long does it take insurance to pay a claim?
It varies by payer and plan. Medicare and many state-regulated commercial plans have prompt payment rules for clean claims, while self-funded employer plans follow their contracts. Electronic claims usually move faster than paper. A claim that is rejected, missing information or pending review takes longer. Track each payer's typical turnaround in your AR reports so you can spot claims that are falling behind.
How long does Medicare take to pay a claim?
Medicare contractors may not pay a clean claim during a waiting period called the payment floor: payment can be issued on day 14 for an electronic claim and day 29 for a paper claim. If a clean claim is not paid within 30 days of receipt, Medicare owes interest. Claims that need development or contain errors take longer.
How quickly must Texas commercial insurers pay?
Under Texas prompt pay law, HMOs and PPO plans regulated by the Texas Department of Insurance must pay or deny a clean electronic claim within 30 days of receipt and a clean paper claim within 45 days. Self-funded ERISA plans, Medicare Advantage and Medicaid are exempt. Providers generally must file with these insurers within 95 days of service. See the Texas Prompt Pay Act article.
What is a clean claim?
A clean claim is one the payer can process without asking for more information. For Medicare, it is a claim that needs no investigation or development outside the contractor's normal operations. In practice that means correct patient and insurance data, valid codes and modifiers, required provider identifiers and supporting documentation on file. The Billing Guide explains the checks in more detail.
What is the difference between a rejected claim and a denied claim?
A rejected claim fails front-end edits at the clearinghouse or payer and never enters processing, so it is corrected and resubmitted. A denied claim was processed and refused payment, with reason codes on the remittance. A denial is handled with a corrected claim or an appeal, depending on the reason. The Claim Denial Codes article explains how to read those codes.
What are timely filing limits?
A timely filing limit is the deadline for submitting a claim after the date of service. Medicare's limit is 12 months from the date of service, and claims denied only for late filing have no appeal rights. Commercial and Medicaid limits differ by payer, plan and contract, so check each contract. The Timely Filing Limits article covers the details.
What does the billing team do when a claim is denied?
First, read the reason and remark codes to find the cause: eligibility, authorization, coding, documentation or a payer error. Then decide whether to correct and resubmit or to appeal, and track the deadline. Fastora's denial management service also looks for patterns, such as one payer or code that denies repeatedly, so the cause can be fixed upstream.
Credentialing
What is provider credentialing?
Credentialing is the process a payer uses to verify a provider's education, licensure, work history and other qualifications before adding them to its network. Payer enrollment is the related step that links the provider to the practice so claims can be paid. Without both, claims are often denied or paid at out-of-network rates. The Provider Credentialing Guide covers the basics.
How long does credentialing take?
It depends on the payer, the provider's specialty and how complete the application is. Some payers move quickly, while others have closed panels or long review queues. Missing documents, an outdated CAQH profile or unanswered payer follow-ups are the most common causes of delay. The article How Long Does Credentialing Take explains what drives each stage.
What are Fastora's credentialing steps?
Fastora follows a tracked nine-stage process: consultation, document collection, state licensing, NPI and CAQH setup, payer applications, panel submissions, follow-ups, final approval and ready to bill. Tracking each stage shows where an application stands and what is still needed from the provider. The Credentialing & Enrollment service page has more detail.
Can providers see patients before credentialing is complete?
They can see patients, but billing those visits is risky. Many commercial payers will not pay for services before the provider's effective date, and some do not allow retroactive dates. Medicare rules on retrospective billing dates are specific and limited. Check each payer's policy before scheduling insured patients with a new provider, and talk with your billing team about how to hold those claims.
Do you handle re-credentialing and CAQH updates?
Yes. Credentialing is not a one-time task. Payers re-credential providers periodically, and CAQH profiles need regular attestation and updated documents such as licenses and malpractice certificates. Fastora's credentialing and enrollment service tracks those dates so a lapsed attestation or expired document does not interrupt payment.
Security & compliance
Will you sign a Business Associate Agreement?
Yes. Fastora signs a Business Associate Agreement before accessing any protected health information. HIPAA requires a covered entity, such as your practice, to have a BAA with a business associate that handles PHI on its behalf, and a billing company is a business associate. The agreement sets out how PHI may be used and protected.
How do you protect patient data?
Fastora's workflows are aligned with HIPAA and HITECH, with encryption, secure server environments, strict access controls and regular internal audits. Because the work happens inside your own EHR/PM system, each team member uses an individual login with the permissions you set, and your system's audit log records activity. You can change or remove access at any time.
Who works on my claims?
Every claim is handled by certified medical billing and coding professionals. Each practice also has a dedicated account contact rather than a rotating call queue, so questions about a claim, a payer or a report go to someone who knows your account. Support is available 24/7, and enquiries receive a reply within one business day.
Who is responsible for coding accuracy?
The provider is responsible for documentation that supports the services billed, and the practice remains responsible for the claims submitted under its name. A billing company reviews codes and modifiers against the documentation and payer rules and flags mismatches before submission. Fastora's coders query the provider when the note does not support the code, rather than changing it without documentation.
Do you use offshore staff or shared logins?
Ask any billing company where its team works, how access is granted and whether logins are shared. Fastora uses individual user accounts in your system, under permissions you control, and signs a BAA before any PHI access. Details about the team assigned to your account can be discussed during the free billing assessment.
What billing reports will I receive?
Fastora provides transparent dashboards plus monthly performance reporting and a monthly review call. Typical reports cover charges, payments and adjustments, AR aging by payer, denial trends and open items needing practice action. Custom reports are available on request. The Analytics & Reporting service page shows the measures most practices track.
Specialties & locations
Still have a question? Talk to our team about your billing workflow.
Which specialties does Fastora bill for?
Fastora works with behavioral and mental health practices, therapy and rehab clinics, physician specialties from internal medicine to cardiology and orthopedics, and facilities such as ambulatory surgery centers and home health and hospice agencies. EMS and ambulance billing is also available. The Specialties page lists each specialty with its billing rules and common codes.
Do you bill for therapists and counselors?
Yes. Fastora bills for psychiatrists, psychologists, therapists, counselors, social workers, MFTs, substance use treatment programs and ABA providers. Behavioral health billing has its own rules for session time, add-on codes, telehealth and authorizations. The Therapist Billing and Behavioral Health Billing pages explain them, and our behavioral health billing guide covers the common CPT codes.
Where is Fastora located?
Fastora Medical Billing Solutions LLC is headquartered in Austin, Texas, at 5900 Balcones Drive STE 38572, Austin, TX 78731. The team serves practices in Austin, Dallas-Fort Worth and Houston, and practices nationwide. All work is done remotely inside each practice's EHR/PM system, so there is no need for visits or in-person meetings.
Do you work with practices outside Texas?
Yes. Because the billing team works remotely inside your EHR/PM system, location does not limit the service. Each state has its own Medicaid program and insurance rules, and each payer has its own policies, so the free billing assessment includes a review of your payer mix and any state-specific requirements.
Do you handle Texas Medicaid claims?
Yes, as part of the payer mix for Texas practices. Texas Medicaid has fee-for-service and managed care components, with enrollment through TMHP and separate managed care organization requirements for authorizations and claims. The Texas Medicaid Billing Guide article explains how the program is structured and what practices should check before submitting claims.
Get answers for your own practice
Book a free billing assessment. We review your claims, denials and AR, answer your questions and explain how Fastora would work with your practice, before you commit to anything.