• It reduces the time your staff spends on processing claims. You may be able to eliminate most of the staff and thus save expenditure on their health care, salary, insurance and training.

• It usually performs better than the in-house staff. They keep their staff updated on insurance regulations and codes. It lessens number of denied and rejected claims.

• Quick to resubmit the claims returned from clearing houses.

• Incentives to increase collections as they are paid a percent of the amount they collect.

• Turnaround from clearinghouses is faster as they process large number of claims with them.

• It saves money by reducing your costs and increasing collections of delinquent account.
  
  

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