Frequently Asked Questions

How is information transmitted back and forth between the practice and the billing service?

Depending on the needs of the client, encounter form information is sent to PBP via mail, courier or accessed electronically over a VPN. Clients have remote, real-time access to their data. Monthly reports are printed and sent out via mail. PBP conducts regular client meetings to review reports and process improvement.

How does the staffing structure work?.

PBP's philosophy is that each client should have more than one biller assigned to their account. Each client has a primary biller that is responsible for the day-to-day processing of their account. Our billers are grouped into teams (usually by specialty) and anyone on the team can provide the same level of service as the primary biller for patient calls or when the primary biller is sick or on vacation. Each team has an account manager that monitors the customer service and data entry accuracy of the billers within that team and acts as a resource for coding questions, ad hoc reports and other client requirements.

What type of standard interaction do you set up with your clients?

PBP conducts monthly meetings during the first several months of the client relationship which allows the client to ask questions directly, observe the progress of the transition and get a thorough understanding of the billing and reporting process. At the client's discretion, monthly meetings can be continued indefinitely or reduced to bi-monthly or semi-annually. These meetings include discussion regarding recommendations for improving processes and data flow between PBP and client and provides coding best practices, tips and suggestions. PBP can also provide training for client's staff regarding coding and process improvement.

What Accounts Receivable system do you currently use

Practice Partner, a premium Health IT services company based in Seattle.

Do you have the ability to interface with an existing system? If so, what system(s) can you interface with?

Yes, we are able to work with Practice Partner to interface with any system that can produce an ASCII or HL7 output file.

Do you offer access to your AR system by the client?

Yes, remote access via Terminal Server. Access can be limited to view only or interactive with granular security to limit access to sensitive or critical data.

What system do you use to bill electronically?

We bill electronically from our Practice Partner system to the Practice Partner clearinghouse. Practice Partner provides an initial claim scrubbing service before the claims are sent on to Emdeon. Emdeon also provides reports on claims submitted. The advantage of this system is that we know same day whether a claim has been rejected, or if there is an error in the data. We can fix the problem and resubmit in a timely manner.

Are you set up to receive any payments electronically?

Yes. We are able to set up the electronic remittance advice (ERA) to come into our Practice Partner system. For those carriers that provide a direct deposit service, the funds can be deposited directly into the client's account.

What is the security system and who has access?

Our security is multi-layered. First, there is a physical security system within our office. Each employee has their own access code so that we are able to track entry and exit by employee. There are two levels of security to access the patient data: one at the network level and another at the Practice Partner level. Each layer of security is customized for each employee so that they only have access to necessary systems and only the Practice Partner databases for which they are responsible. Remote access is password protected and firewall protected. PBB conducts security awareness training and has a non-disclosure agreement in place with all employees.

Do you have regularly scheduled virus checks?

Yes, our antivirus software continually monitors the system and automatically downloads the latest software updates. In addition, our computer system is evaluated throughout the year by an outside professional IT service company that evaluates the system's vulnerability and efficiency.

When is the system backed up and where are the back-ups stored?

The system is backed up daily and the backups are stored offsite.

CPT codes? HCPCS codes? ICD-9 codes?

Our software vendor, Practice Partner, provides annual updates on all codes that can be electronically downloaded into our databases.

Please provide a brief description of the systems you currently have in place to process claims.

We have two different systems to process claims. Paper based information: Claims are reviewed for accuracy and coding and then entered into Practice Partner and transmitted electronically to the PRACTICE PARTNER clearinghouse. Electronically provided information: Claims are reviewed for accuracy and coding and then the approved claim is sent to the PRACTICE PARTNER clearinghouse. Both PRACTICE PARTNER and Emdeon provide error reports that allow us to make corrections and resubmit claims in a timely manner.

What is your staff to account ratio?

Each biller handles 2-3 accounts depending on size and specialty. We keep the biller:practice ratio lower than industry standards; this allows our billers to devote more time to each client to ensure excellent customer service and responsiveness to our client's needs. Other team members and account managers provide back up as required.

What type of up front training do you provide your staff?

All of our staff are certified coders or have commensurate experience. However, all non-certified coders are required to complete coding certification within the first year of employment. All new billers receive training on the Practice Partner system and on PBP's standardized billing procedures before they begin working on client's accounts.

How often is ongoing training done?

Our billers attend a minimum of 2 carrier specific seminars per year. Routine open forums are conducted to allow staff an opportunity to share updated industry best practices and knowledge acquired through continuing education programs. All billers are required to complete 50 CEU credits (including online seminars, coding research and credentialing exam) per year in order to maintain their coding credentials. PRACTICE PARTNER provides software specific training annually at their Users Group Conference. This expectation that every biller be active in increasing their own and PBP's knowledge and expertise is part of what sets us apart from other established firms.

What type of training classes have you provided during the last year?

Our staff have attended the PRACTICE PARTNER Users Group and seminars provided by Medicare, L & I, Regence, and Premera. All certified coders have completed their annual recertification exam.

Do you have a compliance plan in place?

Yes. We also have a compliance officer at the same location as the billing staff.

What is your in-house audit system?

Each account manager conducts random reviews of daily reports showing charges, payments and adjustments. Monthly figures are reviewed for any usual trends (e.g., higher than usual adjustments) Our software system has an audit trail showing any delete or change activity by operator.

What type of HIPAA procedures do you have in place?

Restricted access to Protected Health Information. Security systems in place. Privacy training provided to staff. No PIH used in open communication (such as email). Secure transmission method used for electronic claims transmission. Secure destruction of waste paper generated by PBP. Privacy agreements in place with any vendor that would have access to PIH via PBP systems.

What type of providers have your coders coded for?

Orthopedic, Physical Therapy, Radiology, Ophthalmology, General Surgery, Family Practice, Internal Medicine, Endocrinology, Psychiatry.

CPT Coding? HCPCS Coding? ICD-9 Coding?

The practice is responsible for all coding using PBP as a resource as necessary.

Do you provide any type of training for physicians on coding?

Yes. We provide coding training classes if requested by the client or in response to coding deficiencies identified by PBP. We are also available for ongoing questions that providers may have as they come across any usual or difficult coding scenarios.

Do you provide credentialing services?

Yes. These services are in addition to our usual rate.

Is there a required format for my encounter forms?

No

What types of forms and data is the practice required to submit?

We will review the current forms that the practice uses to ensure that they capture all demographic and charge data that is required.
If the forms are adequate, that practice is welcome to continue to use their current forms. If not, we can provide forms or work with the practice to modify their forms accordingly.

What is your data entry process?

Each biller is required to enter charge data and send claims no later than 2 days from receipt. Payments must be entered no later than 5 days after receipt. Charges are sent electronically multiple times per day.

How often are new claims posted to the AR system?

Daily

How often do you submit claims to insurance companies?

Daily

How do you balance charges to assure that there are no lost batches?

The practice usually supplies us with a copy of the provider's schedule, sign in sheet or encounter form list, and PBP checks that we have charge information for every patient listed on the days that the provider was seeing patients. The practice is notified if any are missing.

What insurance companies do you bill electronically?

We bill electronically to all carriers that accept electronic claims.

Are there any billing processes that your company does not supply, if so what are they?

PBP handles all stages of the billing cycle through to "soft" collections. If there is no response to our initial collection efforts, patients are referred (upon approval by the practice) to an external collections agency.

How do you handle incomplete billing information?

We work with a "point person" within the practice to obtain all necessary billing information. If it is patient related, we call the patient directly and assist in retrieving any missing information.

How often do you send patient statements?

Monthly, more often if requested by the practice.

When are patient statements sent?

We stagger our client statements throughout the month so that the resulting call volume is not too high at any point in the month. We can work with the client if there is a preferred time of the month to send their statements.

Is there a threshold below which a balance is not billed? If so, what is it?

Usually $2.00, but the threshold can be set to the client's specification.

Who has ownership of the data if the contract is terminated?

The client.

Do you have a separate department that handles collections?

The primary biller handles soft collections for their own accounts as they are most familiar with the history of each patient. Because we keep our biller to FTE ratio low, the billers have the time to dedicate to this necessary part of billing cycle. Also, our billers are remunerated based on a series of metrics, including collection rate and days in AR. It is in their personal interest to ensure every dollar is followed up on.

Describe the collection procedure for private pay patients.

If payment is not collected up front by the practice, the patient receives a statement. If payment is not received within 30 days, a reminder notice is sent. If no payment is received after 60 days, a second past due notice is sent. If no payment is received after 90 days, we make several attempts to reach the patient by phone. If unsuccessful, the patient is notified by mail that their account will be sent to a collection agency. We require the client to approve in writing the transfer of any patient account to the collection agency.

If you turn an account over to a collection agency, are the regular rate fees subtracted from the amount due to you when payment is collected?

If an account is turned over to a collection agency, PBP does not collect any fees if payment is eventually received. Therefore it is in our best interest to do everything we can to collect payment before the account ever gets turned over.

How do you verify insurance payments are correct to contract amounts?

Reimbursement is analyzed every 6 months by carrier and matched against contract amounts. Any discrepancy is appealed in writing to the carrier, and correct reimbursement is retrieved.

How do you pursue recovery of underpayments?

If a discrepancy is found during payment posting, the biller makes a call to the carrier and the issue is usually resolved over the phone. If further action needs to be taken, we follow the prescribed appeals process for that particular carrier.

How do you handle Authorization denials?

We work with our practice "point person" to follow up on who is responsible for obtaining correct Authorizations and see if we can clear up any problems. If there is no way of retroactively correcting the error, we keep a log of the incident and include it with our monthly reporting so that the practice can see the financial impact.

What is your procedure for deposits - lock boxes or other?

This varies according to the client. Options are:
Payments come directly to PBP and we deposit into the client's account.
Payments go to a bank lock box, checks are deposited by the bank and paperwork is forwarded to PBP.
Payments go the client. They do their own deposits and forward paperwork to PBP.
If the client provides a check scanner PBP can scan checks into your bank daily.

How are denied claims posted and tracked?

Denied claims are appealed where applicable and remain open while the appeal process is ongoing. If a claim appeal is unsuccessful, the claim is adjusted off using specific adjustment codes that relate to the reason for denial (e.g. coverage terminated, non-covered benefit, lack of prior authorization, etc) so that each reason for denial is easily tracked and reported.

How are credit balances handled?

At the discretion of the client, patient credit balances remain on a patient's account and are applied to future copays or deductibles. If the credit balance remains on the account for more than 6 months, or if the patient requests a refund, we send through a "request for refund" form to the practice detailing the reasons for the refund. Once we receive confirmation that that practice has issued the refund to the patient, the account is debited.

How often are reports run for Credit Balances?

Monthly

Can you provide customized reports?

Yes.

Do you provide a Monthly Dash Board or one page Key Performance Measurement?

Yes, and the format is created with input from the client.

At what point after month end will month end reports available?

10 days after month end at the latest.

What is your claims retention policy?

Electronic record of claims is kept for 7 years. Source documents for charge and payment posting are kept for one year by PBP and then returned to the client.

Are you able to process AR we recover from our previous billing service?

Yes.

How long would it take you to bring a new client up?

One week to set up the database and practice and provider information. At that point we can begin transferring demographics and old AR, and start sending claims on paper. Another three weeks to complete electronic claims setup and carrier address changes.

What are the steps you go through to bring a new client on line?

Meet with client to understand specific needs and goals and to directly address any transition concerns.
Obtain all practice and provider information. Establish any client specific policies on refunds, bad debts, finance charges and late fees, minimum balance statements, account numbering etc.
Install dedicated Practice Partner database for new client and configure providers, fee schedules, adjustment codes, reporting preferences.
Apply for electronic claims submission, submit payment address changes if required.
Begin data entry (or set up electronic transfer) of patient demographics.
Begin claims submission.
Begin follow up on old AR when available.

How do you determine your fees?

PBP charges either a montly percentage based fee or a flat retainer fee. The percentage based fee is the greater of a minimum fee of as low as $250 per month or a percentage of the receipts that we collect for our client. The flat retainer fee negotiated with the client. The percentage rate is determined by the size and specialty of the practice and can range from 4.5% to 10%.

If payment is by percentage is it determined by the amount billed or by the amount collected?

Amount collected.

Is there an additional charge for paper claims?

No.

Is there an extra cost for adding a new physician to the system?

No.

What is the conversion process and the costs involved?

PBP does not charge a conversion fee. PBP and the client determine a start date at which all future claims will be handled by PBP. We can either get all demographics in beforehand (manually or electronically), or we can enter demographics as we receive new claims. (Many practices take this opportunity to have patients confirm and correct their demographic and insurance data). Usually the previous billing company is given 90 days to wrap up any claims that they have in their AR, after which time old AR is transferred to PBP.