Frequently Asked Questions

Total Medical Solutions (TMS) is a healthcare BPO company providing end-to-end outsourcing services to physician practices, health plans, hospitals, and healthcare organisations across the United States. Our services include virtual medical staffing, revenue cycle management, Medicare risk adjustment, insurance claims processing, call center services, healthcare analytics, and back-office operations. We serve 200+ healthcare organisations and operate with a strict HIPAA-compliance framework.

TMS serves the full spectrum of healthcare organisations: independent physician practices (single-provider to 50+ provider groups), multi-specialty and specialty clinics, Medicare Advantage plans and ACOs, community health centres, urgent care networks, home health agencies, long-term care facilities, dental practices, behavioural health organisations, and healthcare technology companies needing operational support. If you operate in healthcare and have administrative functions, TMS can likely support you.

A staffing agency places workers and ends its involvement at placement. TMS is a fully managed outsourcing partner — we handle recruiting, training, onboarding, HR management, payroll, performance monitoring, quality assurance, attendance coverage, and replacement if needed. You direct the work; we own the workforce management. There are no conversion fees, no employment liability, and no disruption when staff changes are needed.

Yes. All TMS staff are scheduled to work during your operating hours in your time zone. Extended coverage — evenings, weekends, and holidays — is available for services like virtual check-in and call center, and is priced separately. We do not ask you to adapt your operations to accommodate our schedule.

Yes. Every TMS staff member assigned to your account works exclusively for you during contracted hours. They do not split time between clients. This dedicated model is what allows them to genuinely learn your workflows, EHR, brand voice, and patient population — delivering performance that a shared-pool model cannot match.

All TMS staff are fully bilingual in English and Spanish. This is standard — not an add-on. For organisations with significant Spanish-speaking patient populations, this dramatically improves accuracy, patient satisfaction, and compliance. Support for additional languages (Portuguese, Haitian Creole, Tagalog, etc.) is available on request with lead time for recruitment.

A TMS Virtual Medical Assistant handles all non-clinical administrative tasks: appointment scheduling and rescheduling, EHR documentation support and medical scribing, prior authorisation submission and tracking, patient follow-up calls, referral coordination, lab and imaging result management, prescription refill coordination, care gap outreach, patient education support, and chronic care management coordination. VMAs do not perform clinical assessments, provide medical advice, or prescribe — those functions remain with your licensed clinical staff.

Yes. TMS VMAs can provide real-time medical scribing — documenting patient encounters in your EHR during the visit via video or audio — or asynchronous scribing from provider recordings. All draft notes are reviewed and attested by the supervising provider before finalisation. This is one of the highest-value VMA use cases, routinely reducing physician documentation time by 2–3 hours per day.

TMS VMAs are trained across Primary Care/Family Medicine, Internal Medicine, Cardiology, Orthopaedics, Neurology, Paediatrics, OB/GYN, Ophthalmology, Pulmonology, Endocrinology/Diabetes, Behavioural Health, Dental, Home Health, and Hospice. VMAs are matched to your specific specialty before onboarding, not trained generically.

Virtual Check-In / Out replaces your physical front desk with a dedicated TMS agent who manages the complete patient arrival and departure process remotely. The agent verifies insurance, collects intake forms, greets patients via tablet or video at arrival, checks them into the EHR, notifies clinical staff, collects copays at check-out, schedules follow-up appointments, processes referrals, and closes the encounter. The average check-in time is under 2 minutes. Agents are bilingual and HIPAA-certified.

There is no minimum or maximum. Clients range from practices adding a single part-time VMA (10 hours/week) to health plans engaging 50+ FTEs across multiple service lines. TMS scales with you — headcount can be added within 72 hours for most roles, or reduced with 30 days notice. No hiring cycle, no severance, no HR complexity.

Absences are covered by TMS at no additional charge. We arrange backup coverage to maintain continuity of your service. If a staff member resigns or you request a replacement for any reason, TMS provides a trained replacement within 5–10 business days. You are never left without coverage or required to manage the replacement process yourself.

TMS provides end-to-end RCM: eligibility and benefits verification, charge capture, medical coding (ICD-10, CPT, HCPCS), claims submission and scrubbing, denial management and appeals, accounts receivable follow-up, payment posting and reconciliation, patient balance management, credentialing support, and financial performance reporting. We manage the complete revenue cycle from eligibility check through final collections.

Most TMS clients achieve first-pass denial rates below 4% within 60 days of go-live. The national benchmark is 7–10%. Specific results depend on payer mix, specialty, and baseline documentation quality. Our average clean claim submission rate across all clients is 98%+.

TMS billers and coders are trained in AdvancedMD, athenahealth, Kareo/Tebra, Epic, Meditech, eClinicalWorks, NextGen, DrChrono, Practice Fusion, Veradigm, Allscripts, and most major PM/EHR platforms. We work inside your existing system — no migration, no new platform, no additional software costs.

Yes. Many clients engage TMS specifically for a denial recovery programme before or alongside ongoing RCM. We audit your denial backlog, prioritise by dollar value and timely filing deadline, and systematically work through outstanding claims. We provide a clear timeline and progress reporting throughout.

TMS certified HCC coders conduct both prospective chart reviews (pre-visit gap identification) and retrospective reviews (post-encounter sweeps) to ensure all documented chronic conditions are coded accurately using CMS HCC v28 guidelines. We identify RAF gaps, coordinate provider documentation addenda, and submit corrected encounters through your EHR. Most clients see 15–20% RAF score improvement within the first 6 months.

TMS manages the payer-facing revenue cycle. For patient-facing statement generation and collections, we work alongside your chosen patient billing solution or can recommend integrated options. A unified patient engagement and collections strategy can be discussed during your consultation.

Yes. TMS operates under a comprehensive HIPAA compliance programme. We sign a Business Associate Agreement (BAA) with every client before any PHI is accessed. All staff receive HIPAA training annually. Data is encrypted at rest (AES-256) and in transit (TLS 1.2+). Access to systems is role-based with full audit logging. We have never had a reportable HIPAA breach.

A Business Associate Agreement is a contract required under HIPAA between a covered entity (your organisation) and any vendor that creates, receives, maintains, or transmits PHI on your behalf. Yes — TMS signs a BAA as part of every engagement before any work begins. The BAA outlines our obligations for PHI safeguarding, breach notification, and subcontractor management.

TMS applies layered security controls: AES-256 encryption for data at rest, TLS 1.2+ for all data in transit, multi-factor authentication for system access, role-based access controls (staff can only access what their role requires), full audit trails for all PHI access and actions, annual security training for all staff, and regular internal audits. We do not store your patient data on TMS systems — we access it within your EHR environment using credentials you control.

Yes. Our IT services division conducts HIPAA Security Rule risk assessments aligned with NIST 800-66 guidelines, evaluating administrative, physical, and technical safeguards. You receive a detailed findings report with prioritised remediation recommendations and support implementing required corrective actions. Annual risk assessments are included as part of our IT services engagement.

Our BAA specifies breach notification obligations. In the event of a confirmed breach involving PHI, TMS will notify you within the timeframe specified in your BAA (typically 5–10 business days of discovering the breach, subject to law enforcement exceptions). We conduct a full incident analysis, provide documentation for your HIPAA breach notification process, and implement remediation. TMS maintains cyber liability insurance covering PHI breach events.

Most TMS services go live within 10–14 business days of contract signing. This timeline covers team assignment, EHR access provisioning, workflow documentation, HIPAA training completion, and a parallel testing period. Larger engagements (10+ FTEs or complex multi-service implementations) may require 3–4 weeks. We provide a detailed onboarding timeline during the proposal phase so you know exactly what to expect.

After contract signing: (1) TMS assigns your dedicated team and introductions are made. (2) We document your workflows, EHR protocols, escalation paths, and brand standards together. (3) Your IT team provisions EHR access for TMS staff. (4) TMS staff complete your workflow-specific training (3–7 days depending on complexity). (5) A parallel period begins where TMS runs alongside your existing process to validate quality. (6) Full handover to TMS once quality benchmarks are confirmed — typically around day 10–14.

To prepare your proposal, we need: a description of the roles or services you need, your EHR and PM system names, approximate volume (e.g., patient visits per day, claims per month), your operating hours and timezone, and any specialty or workflow considerations. During onboarding we will need EHR user accounts for TMS staff, access to your scheduling protocols and workflow documentation, and a designated internal point of contact.

Our standard engagement is a 12-month initial term, which allows both sides sufficient time to optimise workflows and realise the full value of the partnership. After the initial term, engagements convert to month-to-month with 30 days notice. Shorter-term engagements for specific projects (e.g., denial backlog recovery, EHR migration support) are available and discussed case by case.

The fastest path to a quote is a free 30-minute discovery call where we understand your needs and current challenges. From that call we can typically deliver a detailed proposal within 48 hours covering scope, staffing model, SLAs, and pricing. There is no obligation and no cost for the consultation. Book yours using the button below.