FAQ's
Do you stay informed on constantly evolving insurance regulations?
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.