FAQ - Get your questions answered!
Have questions about medical billing and management services? We’re always happy to talk with you, but answers to some of the questions we get asked most frequently are below for your convenience.
What is the main advantage of using your billing service?
Professional Billing & Management Services has more than 30 years of medical billing and coding experience, representing 300+ clients across the country. We’re the medical billing experts! Our outstanding reputation is built on service excellence and the trust we earn through teamwork as we become an extension of your office and work with your staff to increase your revenue.
Is there a minimum revenue that I must generate to qualify for your billing service?
We determine how beneficial our services will be to a particular client based on the size of their practice, growth potential and other factors. We specialize in medium to large physician groups (hospitalists, orthopedic surgery, etc.), but can accommodate specialty practices across the spectrum.
How do we justify paying your company more than we are paying for our in-house billing staff?
You should consider all billing-related expenses that could (and most likely will) increase. Staff salaries may increase, benefit costs may rise, software and hardware support fees escalate and you may need to upgrade hardware or software. You should consider that postage, statements, CMS-1500 forms and other office needs may increase when your practice grows and that you’ll incur additional costs as a result.
At PBMS Inc., your expenses are fixed for the duration of the agreement and may be reduced if your volume increases. As your practice grows, PBMS absorbs the staffing and additional cost requirements while you pay the same rate.
Examples: Consider the fact that in-house employees are paid the same salary and benefits and other costs remain fixed (PCs, phones, etc.), even if your practice generates less revenue month-to-month. If a provider takes two weeks off in the month of July and their gross charges decrease by 50% (example: $100,000 to $50,000), the following month’s net receipts decline by 50%. Your overhead as an in-house biller remains the same. As your billing service, the PBMS rate is based on posted collections for the previous 30 days. In the above example, your August bill will decrease by the same percentage as your gross charges. Therefore, instead of paying your usual percentage of $100,000, your costs will be based on $50,000.
Seasonal variation (flu season, etc.) staff turnover: The cost associated with staff turnover is substantial, which includes the market variable expenses of replacing and training new staff.
By insourcing PBMS, you’ll free up phone lines for patient care and scheduling. You no longer need to spend valuable time managing inquiries associated with claims status or balances owed.
I feel like I would lose control over my billing through outsourcing. How can I be assured that PBMS Inc. is doing a good job?
Please indulge us, and let us ask a few questions:
- How much money do you typically lose from billing errors? (Charges entered incorrectly, timely filing limits missed, misuse of modifiers, revenue lost due to subpar coding etc.)
- How much control do you have now?
- How accountable is your in-house staff?
- How compliant are you?
- How do you know that your in-house staff is doing a good job?
The reality is that clients feel much more comfortable asking hard questions of us, if the need arises, than they do their own employees. And our team is always ready and willing to discuss the work we’re doing on your behalf.
What benchmarks should I look for from a billing service?
Turnaround time from date of service to posting should be no longer than 45 days. This assures a clean claim. PBMS utilizes electronic remittance technology, which has proven to significantly decrease the turnaround time for many of the larger carriers, including Medicare by two weeks and in some cases more. In a few cases, isolated problems arise with claims requiring further review, redetermination or appeal that can add 30 to 90 days or more to the payment cycle.
Over-90-day outstanding insurance claims should not regularly exceed 10% of your gross charges. In the example above, if your total insurance A/R is $100,000, the over-90-day outstanding revenue should not exceed $10,000. In addition, those claims that fall into the over-90-day category should be in some review, appeal or redetermination status.
Our team surpasses all relevant benchmarks!
What about patient-owed balances? Do billing services contact patients who fail to pay their bills or ignore the payment plans they agreed to?
PBMS is not a collections agency. Collection of bad debt is regulated by federal statute, the Fair Debt Collection Practices Act, and is enforced by the Federal Trade Commission. The regulations under the act are complicated and arduous. Infractions are severely fined and could result in prison time. Therefore, PBMS only bills patients, answers patient questions regarding their bills and forwards patient accounts to collection entities as authorized by our clients. No collections are initiated by our billing services.
Are you familiar with mid-level billing?
PBMS regularly bills for services in both incident-to and general supervision settings.