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Practical Management Solutions  is committed to providing clients with high quality, cost effective  medical billing services and is dedicated to meeting the insurance and  patient billing needs of medical practices. We make it a priority to stay abreast of the changes, requirements and challenges involved in the business side of healthcare. Our  account managers have an average of fifteen years experience in medical  billing, coding and/or medical office management.  Our knowledge,  experience, accuracy and dedicated follow-up is demonstrated by our  collection ratios that are consistently higher than the industry average. We relieve clients of the tedious and technical billing and follow-up functions allowing them to concentrate on patient care. We  strive to lower your operating costs, streamline inefficient processes,  automate manual tasks, and increase your revenue and cash flow. We are invested in our client’s success and are 100% dedicated to these efforts.

Why I Should Outsource my Billing Functions? 

Billing your claim and collecting your payment is our priority. We will streamline your billing process while ensuring accuracy and securing your bottom line. In  the typical medical office setting, staff is busy with other office  duties and often billing and follow-up functions are not given the  attention they require. If your  staff is “squeezing in” the billing function as time allows, has  insufficient time or training required to work claim rejections, and is  not following up on outstanding claims, your cash flow is suffering.

Is Outsourcing Cost Effective?
Aside  from increased revenue and stabilized cash flow, offices typically  experience a reduction in personnel costs, a reduction in office supply  expenses, a savings in hardware and software maintenance contracts, a  reduction in stress over the entire billing process, and often regain  use of valuable work space. Practice  expenses decrease as software support fees, telephone expense,  stationery, and expensive computer toner supplies decrease significantly  or disappear entirely. Hiring and retaining qualified staff is another challenge faced my many practices. Losing  your key billing person to maternity leave, illness, retirement, etc.  can have a serious long-term impact on your cash flow.

What Access do I have to my Billing Data?
Access to your data is available via a secure, HIPAA compliant connection to our server. All  you need is a PC and high speed access to the Internet. There are no  costly software updates or support fees.  There are no hidden costs or  additional charges aside from the initial start up costs.  Your  office is encouraged to utilize our system for patient lookup,  generating superbills, visit authorization tracking, and appointment  scheduling if desired. Our software is upgraded regularly to accommodate the evolving changes in our healthcare system.  

 How will your staff integrate with ours?

Our staff essentially becomes an extension of your office. By  utilizing the tools available on our server, your staff can access the  patient demographic database and schedule appointments in our system  taking advantage of software features such as real-time patient  remainder balance reporting, printing receipts for copays collected at  the time of service, tracking visit authorizations, and account alerts  that appear when scheduling a visit for a patient whose account needs  specific attention, such as an information update.  

How do you get my patient information?    

Since  every office is different, we customize a system that meets both our of  needs.   Generally, the provider's office gives us the patient  demographic and insurance information for new patients after having  verified the coverage and obtaining any necessary authorizations.  New  patient information is generally communicated to us via fax or email.   The patient information is built into our system so we do not need  further demographic or insurance information on this patient unless the  information changes.  Practices are encouraged to ask patients upon each  visit for any changes to their information and have the patient to  review his information and provide an updated "signature on file" on an  annual basis. 

How do you know what charges to bill?
On  a daily basis, if possible, the office sends us the charge (including  CPT and ICD-9 codes) and copayment information for the day.  This  information is generally communicated to us via fax or email.  This  information can be communicated by providing us with your superbill or a  charge list if possible.  We work with you during the initial setup to  design or modify superbills and charge lists that work best for  your specialty and practice preferences to help facilitate getting us  the information we need as efficiently as possible.  For specialties  where the diagnosis does not potentially change for every visit, we  record the ICD-9 codes applicable to the current treatment being  rendered.   If the practice utilizes our appointment scheduling  software, the diagnosis code(s) on file for the patient can be printed  on the superbill or charge list so the provider is always aware of the  diagnosis codes we already have on file.  Therefore, if there is no  change in the patient's diagnosis, the provider does not have to provide  codes for every visit and instead only needs to tell us when/if the  patient's diagnosis changes.

How often do you work on my account and bill my charges?
Charges  and payments are posted on a daily basis and claims are electronically  filed each day to keep the patient's account up-to-date in our system  and to bill the insurance carrier for your services.  Our preference is  to receive charge information from you every day allowing us to bill  your charges within 24 hours of receipt.  If you send us your charge  information at the end of each work day, we process that work the  following business day.  Some practices prefer to send charge  information on a weekly basis.  In those cases, we strive to process the  charges received in bulk within 24 to 48 hours of receipt depending on  the volume.

How do I get paid?
All  claims are billed under the provider's name and ID numbers, and all  remittances will be made payable and directed to the provider as usual.   Your office will continue to receive insurance payment and explanation  of the patient's insurance benefits (EOB's).  Your office should  continue to deposit your insurance checks into the bank as usual, but  should route the EOB to us for processing.  Providers who utilize a  lockbox for their deposits simply need to supply us with the information  needed to obtain the lockbox remittance information.  We retrieve  electronic payment information directly from the carrier for any  payments that are automatically deposited by the insurance company into  the practice's bank account (EFT).  Upon receipt of the EOB, we post  transactions, by the line item so that detailed remittance information  is recorded.  Zero payments, such as deductibles, are recorded and any  appropriate charge adjustments as a result of contracted allowables are  made in order that the second insurance company or patient be accurate  and promptly billed for any amount due.  We prefer to reconcile our  postings to your bank deposits if the office can provide that detail  with which to balance.  This helps to ensure that all receipts reported  were deposited and that all deposits were reported, keeping your account  balances as accurate as possible.

How often are outstanding claims worked?
We  pursue delinquent insurance claims until resolved.  Claims for which we  receive an EOB but are not satisfactorily processed by the carrier are  worked on a daily basis.  Insurance aging reports are generated and  worked on a monthly basis to facilitate follow-up on those problem  claims and to review claims for which we have received no response from  the carrier.  Claims out to the primary carrier appear on our  worklist 30 days after the claim was last filed.  Claims out to the  second and third carriers appear on our worklist 45 days after the claim  was last filed, as those 2nd and 3rd claims typically take longer to  process with the carrier.

Do patients receive statements for any allowed amount not paid?
Patients  statements are generated on a monthly basis for any remaining balance  allowed but not paid by the insurance carrier(s).  If the office has  collected the appropriate copay and/or applicable deductible at the time  of service, there is often no balance remaining after the insurance  processes.  Since this is not always possible, patients are sent bills  to help capture payment of the patient's portion due for the services.

What if patients do not respond to billing statements?
We  will send as many statements as are required as long as there is  payment activity on the account.  However, for patient balances where  payment activity has ceased, a maximum of three statements will be  sent.  After the third statement with no response, billing is suspended  and the provider is notified of the account status.  Such past due  accounts are handled on a case by case basis from that point under the  direction of the provider.  We are not a collection agency and therefore  do not make multiple calls to patients in an attempt to collect their  past due balance.  We will however, upon approval from the provider,  forward delinquent accounts to an outside collection agency.

How does the billing service get paid? 
Upon  the close of each month after confirmation that all charges and  receipts for the month have been posted, month-end reports are generated  that detail charge and payment statistics.  Our billing fee is  calculated based on the payment statistics reported.  The reports and  our invoice are then forwarded to you as part of our month-end reporting  process.

What if I need help with Procedure and Diagnosis Coding?   

Coding  services are available, at an additional charge, for providers who  need assistance in converting medical procedures and diagnoses into the  numerical codes required by insurance carriers for the submission of  claims.  We have a certified procedural coder (CPC) on staff to assist  in this process and to help appeal any claims denied by insurance  carriers as a result of coding or medical necessity issues.

Why is using your Appointment Scheduling Software beneficial?   

Your  use of our appointment scheduling software provides your office with  the ability to print appointment lists, superbills and/or charge lists  directly from our server that will contain the up-to-date information  about the patient and his account with your office.  Information  typically communicated on our appointment reports include the status of  Prior Authorizations helping to ensure that the patient has not  exhausted his authorized visits and that the authorization has not  expired. Patient copay amounts and prior balances are reflected  providing your staff an opportunity to collect at the time of service.   Use of the software also provides access to current address  and insurance information on file for verification and  update purposes.   When scheduling appointments, any warnings we have  placed on an account relative to the need for updated information or  issues such as terminated coverage, returned mail, returned checks, etc.  are visible to your office staff.  Our system provides the scheduler  with the opportunity to add that warning message to the appointment list  to help ensure the issue is handled when the patient is in your  office.   In addition, if your staff logs into our system on a regular  basis for scheduling purposes, they would find it convenient to use our  inter-office email tool which makes communicating any account  issues very efficient.

I'm Convinced!   How do I get started? 
Call us at (843) 408-4162, email us at info@pmsmail.net or complete the Contact Us inquiry  on the website to indicate your interest.  We will review the  procedures with you, answer any questions you may have, and quote our  billing fee based on your specialty and specific practice needs.  We  will then send you our Billing Service Agreement, a HIPAA Trading  Partner Agreement, and a Provider Information Sheet that will give us  the information about your provider(s).  We enroll you with our  preferred electronic clearinghouse so we can transmit electronic claims  on your behalf and do any necessary paperwork to gain approval to send  electronic claims to insurance carriers that need specific written  authorization, such as Medicare, Tricare and Medicaid.  In the  beginning, every patient is "new" to our system so we will need complete  patient demographic  and insurance information for established patients that undergo  treatment.  We work with you to decide the best method of obtaining this  information.  Most practices prefer to provide the information on an as  needed basis as the patients are seen and we build the database as we  go.  However, in some cases it is advantageous to provide us patient  information for all patients you actively treat and we do a one-time  file build based on that information.  We will also need to obtain from  you a list of your common diagnosis codes, common CPT codes and your  fees for those procedures.  Once your basic company file is set up in  our billing system, we are ready to start receiving patient and  charge information.  At that time, we also schedule a training  session with you and your staff regarding connecting to our  server, accessing your database, and utilizing our appointment  scheduling software and internal emailing software, if applicable.