Primary Billing Solutions Let us take care of your billing needs while you take care of your patients

Primary Billing SolutionsPrimary Billing Solutions

Let us take care of your billing needs Let us take care of your billing needs while you take care of your patientswhile you take care of your patients

Let us take care of your billing needs while you take care of your patientsLet us take care of your billing needs while you take care of your patients

LOST REVENUELOST REVENUE

• Without proper follow up on your claims, you could be Without proper follow up on your claims, you could be losinglosing thousands of dollars and without even knowing it.thousands of dollars and without even knowing it.

• What follow up is being done with your current biller?What follow up is being done with your current biller?• Does your current biller have a LVN coupled with CPC Does your current biller have a LVN coupled with CPC

(Certified Professional Coder) credentials? (Certified Professional Coder) credentials? • Does your current biller have experience in Risk Adjustment?Does your current biller have experience in Risk Adjustment?



Primary Billing Solutions…Primary Billing Solutions…• Will research all your insurance claims to determine the reason Will research all your insurance claims to determine the reason

for denial, non-payment, non-delivery of each claim, through our for denial, non-payment, non-delivery of each claim, through our internal operational strategies of telephone calls to insurance internal operational strategies of telephone calls to insurance carriers and patientscarriers and patients

• Will appeal all denied claims for reason other than eligibility Will appeal all denied claims for reason other than eligibility issuesissues

• Gets the patients involved to solve carrier issuesGets the patients involved to solve carrier issues

• Based on above information and our many years of Based on above information and our many years of experience, Primary Billing Solutions will correct all necessary experience, Primary Billing Solutions will correct all necessary claim information and resubmit those claims that we feel has a claim information and resubmit those claims that we feel has a reasonable chance of being paid at NO additional cost to youreasonable chance of being paid at NO additional cost to you


Healthcare Healthcare Provider's Top Questions... Provider's Top Questions...


How quickly do we get reimbursed?How quickly do we get reimbursed?

• The average turnaround in the industry is 30-45 days. The average turnaround in the industry is 30-45 days. Obviously, some are more and some are less. You may Obviously, some are more and some are less. You may sometimes see different software or billing firms tout sometimes see different software or billing firms tout “you will get reimbursed in two weeks with our firm!“you will get reimbursed in two weeks with our firm!” ”

• The fact is that Medicare/CMS is promoting EFT The fact is that Medicare/CMS is promoting EFT (electronic funds transfer) all electronic claims are (electronic funds transfer) all electronic claims are typically paid out within 7-10 days typically paid out within 7-10 days

• Commercial payers are following suite with CMS Commercial payers are following suite with CMS paying claims within 14 days is an exception and paying claims within 14 days is an exception and certainly not the rule. The National average for Days In certainly not the rule. The National average for Days In AR (for Family Practice) is 43AR (for Family Practice) is 43


Will you submit secondary insurance, tertiary? Will you submit secondary insurance, tertiary?

• Secondary resubmissions are included in our service. Secondary resubmissions are included in our service. However, tertiary processing is not. However, tertiary processing is not.

• The reason: usually one ends up processing a claim for The reason: usually one ends up processing a claim for $5.00 and by the time you hear from the tertiary $5.00 and by the time you hear from the tertiary company, the time frame is 6 months which is hardly company, the time frame is 6 months which is hardly worth it for the provider. We suggest having the patient worth it for the provider. We suggest having the patient pay and then get reimbursed from the tertiary.pay and then get reimbursed from the tertiary.


What is your average collection rate?What is your average collection rate?

• First you should define “collection rate”. The “Net” First you should define “collection rate”. The “Net” definition is defined as: payments divided by gross definition is defined as: payments divided by gross charges, minus adjustments. charges, minus adjustments.

• Our average “Net” collection rate is 90% to 93% of Our average “Net” collection rate is 90% to 93% of your allowed amounts (based on payer contracted your allowed amounts (based on payer contracted rates). rates).

• The National Average for Primary Care providers is The National Average for Primary Care providers is 92% for Net, and 65% Gross collections.92% for Net, and 65% Gross collections.


How quickly can we be up and running? How quickly can we be up and running?

• We prefer 2 weeks to ensure the smoothest transition We prefer 2 weeks to ensure the smoothest transition possible. possible. (This is also dependent upon credentialing if you are a new (This is also dependent upon credentialing if you are a new practice which may take longer) practice which may take longer)

• We like to start at the beginning of the month so that it is We like to start at the beginning of the month so that it is easier for you to separate your previous dates of serviceeasier for you to separate your previous dates of service


How do we get How do we get existing patientexisting patient data to you? data to you?

• There are 2 options: There are 2 options: – A complete printout from your existing system of patient information and A complete printout from your existing system of patient information and

insurance infoinsurance info

– Provide to us the most current patient information as you see them (Pt. Provide to us the most current patient information as you see them (Pt. information sheet & Insurance card). This also gives you the opportunity to information sheet & Insurance card). This also gives you the opportunity to “start fresh” with your data and have your patients re-register, which is “start fresh” with your data and have your patients re-register, which is recommended annuallyrecommended annually


How do we get our data to you routinely?How do we get our data to you routinely?

• You can have them faxed, mailed (USP “Priority Mail”) or You can have them faxed, mailed (USP “Priority Mail”) or submitted to us electronically through a secure internet submitted to us electronically through a secure internet connection connection

• We will provide a pick up service once or twice per week We will provide a pick up service once or twice per week (within a 15 mile radius)(within a 15 mile radius)

• If you choose the electronic method, our software also If you choose the electronic method, our software also includes a Scheduling component, which makes it very easy includes a Scheduling component, which makes it very easy for you to print superbills, maintain patient demographics, and for you to print superbills, maintain patient demographics, and get the data to us immediately on a daily basis. The monthly get the data to us immediately on a daily basis. The monthly cost for this method is $225 cost for this method is $225

• With the continuous rise in postal rates and gas, many clients With the continuous rise in postal rates and gas, many clients are using this method are using this method


How often are my claims processed?How often are my claims processed?

• Within 72 hours of receipt we will prepare your claims for Within 72 hours of receipt we will prepare your claims for processing. processing.

• Obviously, if we need to gather additional information from Obviously, if we need to gather additional information from your practice, we will reach out to you for that information, your practice, we will reach out to you for that information, and prepare for processing upon completion of receipt of that and prepare for processing upon completion of receipt of that information.information.


How do I set my fees and will you assist in How do I set my fees and will you assist in watching reimbursements?watching reimbursements?

• We advise most of our clients when setting fees We advise most of our clients when setting fees initially, or re-setting your fees to work from the initially, or re-setting your fees to work from the Medicare fee schedule Medicare fee schedule for your area and multiply by for your area and multiply by 130% or 1.3 130% or 1.3

• We will continually monitor your reimbursement We will continually monitor your reimbursement rates to make sure that you are maximizing your rates to make sure that you are maximizing your reimbursements with correct fees and codes, and we reimbursements with correct fees and codes, and we will provide the appropriate advice when deemed will provide the appropriate advice when deemed necessarynecessary


Why do some billing companies charge by the Why do some billing companies charge by the claim claim versusversus a percentage of collected revenue? a percentage of collected revenue?

• Many billing companies will charge you a flat fee per claim Many billing companies will charge you a flat fee per claim because they are normally only skilled in the initial because they are normally only skilled in the initial “transmission or submission” of the claim to the insurance “transmission or submission” of the claim to the insurance company. company. This is something you could do internallyThis is something you could do internally

• Most tenured billing companies will charge you a percentage Most tenured billing companies will charge you a percentage of what they collect of what they collect

• They are more compelled to work harder, follow through with They are more compelled to work harder, follow through with secondary submissions, denials and work to get you the secondary submissions, denials and work to get you the highest reimbursement possible – a “win-win” for bothhighest reimbursement possible – a “win-win” for both


Where does my money go?Where does my money go?

• All payments come directly to your office, unless your All payments come directly to your office, unless your current biller is receiving them current biller is receiving them

• If you choose we have set up a PO Box for all If you choose we have set up a PO Box for all payments, changing your “pay to” address with each payments, changing your “pay to” address with each insurance companyinsurance company

• You then send us the copy of the checks and the EOBs You then send us the copy of the checks and the EOBs along with your daily super bills / encounter forms along with your daily super bills / encounter forms

• This way we can appropriately track and close the loop This way we can appropriately track and close the loop on all reimbursement activity on all reimbursement activity

• We scan all of the EOBs for electronic storage and for We scan all of the EOBs for electronic storage and for your future reference should you need themyour future reference should you need them


How much experience do you have?How much experience do you have?

• Our staff has over 20 years experience in billing/collections Our staff has over 20 years experience in billing/collections • We have Coders, Nurses, Collectors and Risk Adjustment We have Coders, Nurses, Collectors and Risk Adjustment

specialists on staffspecialists on staff• 90% of billing is billing, no matter what the discipline. The 90% of billing is billing, no matter what the discipline. The

10% differences tend to be discipline specific nuances10% differences tend to be discipline specific nuances• We have experience that is made up of everything from We have experience that is made up of everything from

Family Medicine, Internal Medicine, Urgent Care, to Family Medicine, Internal Medicine, Urgent Care, to Allergy/Asthma to Surgery, Psychiatry, Physical & Allergy/Asthma to Surgery, Psychiatry, Physical & Occupational Therapy, Chiropractic, Cardiology and Occupational Therapy, Chiropractic, Cardiology and Hospitalists, etc…Hospitalists, etc…


How do I know that you will be more effective How do I know that you will be more effective than our current biller? than our current biller?

• First, effective billing must be definedFirst, effective billing must be defined

• We do more than process claims (see the Service Proposal) We do more than process claims (see the Service Proposal)

• Our timeliness (claims processing), consistency (no leave, no Our timeliness (claims processing), consistency (no leave, no vacation, no absenteeism of staff), accuracy (we do not send out vacation, no absenteeism of staff), accuracy (we do not send out claims with incomplete data), which generally results in increased claims with incomplete data), which generally results in increased cash flowcash flow

• The fact that we have Certified Professional Coders (CPC) on staff, as The fact that we have Certified Professional Coders (CPC) on staff, as well as an LVN, and experienced Risk Adjustment specialists pretty well as an LVN, and experienced Risk Adjustment specialists pretty much guarantees your claims are receiving the best possible much guarantees your claims are receiving the best possible reimbursement value than any other service offered to you in the reimbursement value than any other service offered to you in the industryindustry


Ancillary Services OfferedAncillary Services Offered

• Risk Adjustment Chart ReviewRisk Adjustment Chart Review• Superbill analysis & revisionSuperbill analysis & revision• In-services: In-services:

– Front Office Structure Front Office Structure • Getting the correct information for Optimal ReimbursementGetting the correct information for Optimal Reimbursement

– Back Office Structure Back Office Structure • Time management & Back Office ComplianceTime management & Back Office Compliance

– Physician Education for Documentation and CodingPhysician Education for Documentation and Coding

• CredentialingCredentialing


Questions?Questions?

(714) 277-4123 (714) 277-4063 fax(714) 277-4123 (714) 277-4063 fax

www.primarybillingsolutions.comwww.primarybillingsolutions.com

[email protected]@primarybillingsolutions.com

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Primary Billing Solutions Let us take care of your billing needs while you take care of your patients