Home of the Blue plan

Florida Blue is headquartered in Jacksonville, and that fact tells you something about the commercial market here. The plan is large, and most practices in the city bill it. If a billing company does not know how that plan pays, or how it handles denials and prior authorization, it is not ready for Jacksonville.

Add Medicare Advantage, which is big in a state with this many retirees, and Medicaid managed care plans. TRICARE covers the sailors and families around Naval Station Mayport and Naval Air Station Jacksonville. Four sets of rules in one waiting room is normal.

Because the plan is local, its policies are well known to Jacksonville billers. That is an advantage if you pick a company with Florida experience. A company that has never worked the plan will learn its quirks on your claims, and you will pay for the education.

Jacksonville is also close to the Georgia line, and some patients arrive with plans written there, which have their own rules for referrals and out of state care. Check the card carefully at check in.

Large hospitals, plenty of room for independents

Baptist Health, Ascension St. Vincent's, Mayo Clinic's Florida campus, UF Health Jacksonville and Nemours Children's Health are the large names. Most have physician groups of their own, and Brooks Rehabilitation runs a large therapy operation. Independent practices do well in the gaps, such as orthopedics around San Marco and cardiology near the Southside medical corridors.

Staying independent here means competing with systems that have large billing offices. An outsourced company can give a five-provider practice some of that muscle without hiring a department.

Mayo Clinic's Florida campus draws patients from out of state, so nearby practices see referrals from people carrying out of state coverage. Those claims follow the home plan's rules, not Florida's, and they are easy to get wrong.

Medicare Advantage is where claims go to die

In Florida, many patients are on Medicare Advantage plans from several carriers, and each plan has its own authorization and referral rules. A card that says Medicare is not enough. A billing company that checks eligibility on the day of service, and again before submission, will see fewer denials than one that trusts the front desk.

Ask how the company handles Medicare Advantage in particular. A good answer includes a person, a process and a reason. A bad answer is "we are experienced."

Prior authorization is where much of the trouble starts, especially for imaging and therapy. Ask whether the company handles authorizations or leaves them to your front desk, and who is responsible when one is missed.

Jacksonville Beach, the Southside and Orange Park

Jacksonville is huge by area, which means practices spread out. Jacksonville Beach and the other beach communities have primary care and urgent care offices for a young and active population. The Southside and Baymeadows have large clusters of specialists. Mandarin and the Westside have growing family practices.

The sprawl makes no difference to billing, since the work is remote. Tell the company where your offices are and how many locations you have. If you have several, ask for reports that split out each site and provider.

Jacksonville also has a large rehabilitation and therapy sector, and urgent care and occupational medicine offices near the port and the industrial areas on the north side. Those practices have different billing rules than a primary care office. Ask for experience in yours.

The port and logistics economy means many patients work for employers that self-insure, and occupational medicine offices see workers' compensation claims alongside regular visits. Ask if it takes them on, because they run on separate forms and timelines.

Storms and cash flow

Hurricane season can close offices for days, and some practices fall behind on claims after a storm. A billing company that already has your data does not stop when your office does. Ask how the company handles a disruption: can it keep submitting from remote copies of your schedule, and will it help rebuild the backlog afterward?

Low-lying streets along the St. Johns River and the Intracoastal tend to flood first, so ask where the backup copies of your schedule live and who can reach them when your office cannot. Ask how the company hands back records and reports after a storm, too, in case you need to document a closure for an insurer. Patient volume often returns all at once after a closure, and that means a pile of claims to code and submit in a single week.

Before you sign

Software comes first. Which billing and EHR systems does the company work in every day? If yours is not on the list, ask who builds the connection and pays for it.

Then the exit. Who owns the data when you leave, and what happens to open claims?

Then results. How are denials worked and reported, and who sees them? Ask to see how fast claims get paid and how old your open balances are. Ask where the staff sit and which of them are HIPAA-trained.

A contract with a clear exit and a short notice period is worth more than a small rate difference. Jacksonville has plenty of billing companies. You can afford to walk away from the one that will not put its exit terms in writing.

Medical Billing Cost Costs in Jacksonville

The cost of a medical billing company in Jacksonville is most affected by the volume of bills a practice needs to process and collect.

Below are estimated costs for medical billing company costs in Jacksonville:

Size of Practice	Setup Fee	% of Collections	Min Monthly Charge
Small (< 10 Physicians)	$288.51 / Physician	3-5%	$817.45 - $1,442.55
Mid-Size (10-20 Physicians)	$480.85 / Physician	5-8%	$1,442.55 - $2,404.25
Large (> 20 Physicians)	$961.70 / Physician (capped)	8-11%	$2,404.25 - $3,365.95

Note: Prices subject to change. These costs are based on an average of Alluvit's Jacksonville medical billing company research.