PFMS will: (a) Edit/scrub claim form prior to submission and notify medical provider of incomplete medical claim which were unable to be processed  (b) Electronic/paper claim submission to primary and secondary commercial payers within 2 business days from date of service (c) Post to patient accounts self pay and insurance carrier payments  (d) Produce in-depth claim acknowledgment reports that includes claim detail as well as information needed in order to perform in-office tracking (e) Generate patient statements on  monthly basis to any patient with a balance due and (f) Prepare computerized end-of-month reports that reflect all A/R production totals.

PFMS addresses the reimbursement issues of insurance claim denials, delayed A/R and other variables that decrease a healthcare organization’s cash flow by taking responsibility for the following within 45 days of service: (a) Following up with insurance carriers to assure claims have been accepted (b) Calling insurance carriers to check the status of non-paying claims (c) Tracking unpaid procedures and sending appeal letters when necessary (d) Research and resubmitting non-paying claims to an insurance carriers (e) Notification to medical providers regarding any incomplete claims which were unable to be processed as a result, or when additional information is required by the insurance carrier to adjudicate the medical claim for payment and  (f) Receive all patient/insurance carrier inquirers.

PFMS will oversee the processing of: (a) Accounts receivable financial computer data entry (b) Electronic/paper medical insurance claims being filed using a clearinghouse (c) Patient statements   (d) Computer software maintenance and (e) Complete end-of-month balancing and computer system update.

PFMS provides its client's with appropriate data, which helps them, make informed decisions regarding their practice. The basic monthly reports are prepared and presented in a graphic format. The standard reports include: (a) Analysis of charges, payments and adjustments showing month-to-date and year-to-date with prior year comparisons (b) Aged accounts receivable analysis (c) Medical Provider productivity reports (d) Payer analysis (e) Practice production/facility analysis and (f) Payment analysis by procedure. Additional A/R MIS reports can be developed upon request.

On a regular basis, a PFMS management staff member will conduct with the medical provider (s) and their management staff a personalized patient accounts receivable performance and analysis meeting.

PFMS will provide detailed information by insurance carrier with billed procedures, payments, adjustments, patient payments and net profit based upon standard costs.  Also, PFMS will analyze all procedures billed to an insurance carrier or contracted fee schedule and indicating average days to pay.

Initially, as a new billing client we will need to set you up within our computer systems (CollaborateMD) and with our claim processing clearinghouse and/or carriers.  The set up and registration includes: (a) Applying for EMC approval (b) Computer set up (configuration) of Medical Provider information (c) Computer data entry of electronic insurance companies participating with a medical provider (d) Data entry of procedure codes and diagnosis codes used in the practice (e) Data entry of current fee schedule and (f) Set up of treatment locations.

PFMS provides a variety of patient accounts receivable (A/R) reimbursement training and front office staff training.  Will also assist client's personnel with education on computer systems (CollaborateMD software) and other required technical areas.  PFMS may perform training and education on Healthcare Compliance (see below).

n  View the PFMS Resources & Support Section for more information

 

PFMS will work to solve past due patient account balances in an “in-office” atmosphere while retaining patient goodwill with the medical provider and reducing the need for an outside collection agency or writing the patient account off to bad debt. PFMS will perform the following accounts receivable recovery services: (a) Monthly review all patient accounts in a 90/90+ in a non-payment status (b) Politely, timely and consistently perform a telephone audit call to those patients with balances greater than $15.00 for the purpose of resolving non-payment. Telephone calls will be performed in the evening hours Monday -Friday (5:30 PM to 8:45 PM) and Saturday (8:30 am to 11:30am) (c) Each month conduct a performance review and note in the computer telephone results (d) Generate documentation for final account resolution at 120 days past due and (e) Submit a non-payment patient account for write-off approval or placement with an outside collection agency.

PFMS will assist client’s providers in insurance companies for Provider Numbers to bill for payments, completing necessary credentialing apps/contracts. PFMS will (a) set up clients for Electronic Claim Submission, Electronic Remittance Advices (ERA’s) and Electronic Funds Transfer (EFT) (b) follow up with insurance companies until credentialing/contracting has been completed and Provider Number(s) are received.  This applies to clients who have left a group practice and become solo and existing clients who change Tax ID.  Close communication with [CLIENT] regarding credentialing updates and any potential issues.  PFMS will work to resolve and credentialing issue with insurance companies.

PFMS will review fees charged by a medical provider for services provided annually.  We use national evaluation tables to audit fees and make recommendations.  Implementation of fee changes is a medial provider’s decision.  As always, medical provider’s information is kept confidential.

If client does not have proper compliance program integrated within the organization, PFMS will assist in the development, maintenance and management of a program consistent with all applicable federal, state and local laws, rules and regulations.  Healthcare Compliance Internal Resources (HCIR) is a subdivision of PFMS and was created to assist in creating an “effective” compliance program promulgated by the Office of Inspector General of the Department of Health & Human Services.  For more information, see section 16 for further details on Healthcare Compliance.

n  Visit HCIR Online at www.hcir.net | www.whatiscompliance.com

n  Download the HCIR/PFMS Compliance Brochure (PDF)