Q. WHY SHOULD I USE A MEDICAL BILLING SERVICE?
A. The medical billing industry today is not as it was several decades ago. HMO's PPO's EPO's POS's and the rest of the insurance alphabet have conspired to drive providers crazy. Outsourcing is the sane and productive way to get paid for your work. Just as your specialty is helping people to stay healthy, ours is helping your finances stay healthy.
Q. HOW LONG HAVE YOU BEEN IN BUSINESS?
A. PBA has been in business since 1986 and has been billing for anesthesiologists and surgeons for over 20 years.
Q. WHAT TYPES OF SPECIALTIES DO YOU BILL?
A. PBA bills for anesthesiologists general surgery and pain management. We bill for providers in hospitals, offices and free standing ambulatory centers. We bill for single providers as well as large multiple location groups.
Q. HOW DO WE GET STARTED?
A. Once you have reviewed and signed your agreement you will then send in specific provider information which we will enter into our billing system. We then contact all carriers with your new correspondence information. We will be able to bill most carriers immediately on paper while we set up electronic accounts. Shortly thereafter, we will bill electronically where applicable.
Q. HOW LONG WILL IT TAKE TO GET STARTED?
A. Once you are signed on, you can start sending your work to us. We will notify carriers of the changes and bill out your work right away.
Q. HOW DO WE GET OUR INFORMATION TO YOU FOR BILLING?
A. We recommend either fax or priority mail.
Q. DOES YOUR OFFICE CREDENTIAL PROVIDERS?
A. Always! It is a standard service and included in our fees.
Q. WHAT IF I AM A NEW DOCTOR?
A. Don't worry it will take a little longer to get started but you'll be fine. We will work with the insurance carriers to get your credentials established and will negotiate for participation with all viable carriers.
Q. WILL YOU NEGOTIATE WITH CARRIERS FOR PARTICIPATION?
A. Yes, and we will make sure to get you the best agreement possible. We will also advise you which carriers merit participation and which do not. We know how to get you the highest reimbursement for your work.
Q. WILL YOU TAKE OVER MY OLD WORK?
A. YES! We will make every effort to get you fully reimbursed.
Q. DO YOU BILL ELECTRONICALLY?
A. Yes, wherever applicable.
Q. ARE YOU HIPAA COMPLIANT?
A. Absolutely, everyone should be.
Q. WILL YOU DO THE BOOKKEEPING FOR ME?
A. Yes, we will take care of all billing, deposits, research and review for additional payments and posting of all payments. A report will be sent to you twice a month.
Q. WILL YOU BE MY OFFICE?
A. Of course! We know how hard medical professionals work. You don't need to be bogged down by hours of paperwork. We do the work and report back to you. Our reports are easy to comprehend. We believe in accountability which allows our clients the peace of mind to care for their patients.
Q. WHAT ARRANGEMENTS ARE MADE TO PAY FOR SERVICES?
A. We are paid only for claims we collect on. We will settle these accounts with you every two weeks and you will receive a detailed report of all receipts and fees.
Q. HOW MUCH EXPERIENCE DO YOUR REIMBURSEMENTS SPECIALISTS HAVE?
A. We have specialists who have been in the industry for over 20 years and have worked in all aspects of claims reimbursement.
Q. WHAT COURSES AND CERTIFICATIONS HAVE YOU COMPLETED?
A. Our staff is always learning and growing. For example, we have completed:
Certified Compliance Training
Anesthesia coding and compliance courses
Medicare Training Courses
And we have professionally trained telephone collectors
Q. WHAT HAVE YOU DONE TO MAKE ANESTHESIA BILLING BETTER?
A. We are a strong advocate for anesthesia billing. In 2000 we spearheaded a successful campaign opposing Blue Cross Blue Shield's intention to change their payment policy. We have been instrumental in campaigns to block negative policy changes of other carriers too - including Healthnet, GHI and Oxford. We have sent streams of effective letters to insurance carriers Medical directors, CEO's and even the ASA, with salient arguments that have won the day. Recently, Aetna expressed its desire to stop paying for conscious sedation and MAC in office settings. We were a crucial part of the massive drive to stop them. We are currently taking issue with Aetna again, for their intended payment reduction for non participating providers. We have also been successful in presenting arguments with out of state carriers who change their policy without advising members or out of state providers. Under no circumstances will we allow any insurance carrier to put their financial interests above the well being of your patients.
Q. HOW IS FOLLOW UP HANDLED?
A. We are aggressive with insurance carriers. We call carriers regarding unpaid claims and send written inquiries for improperly paid claims. Calls and inquiries are done on a daily basis. Patient follow ups are done professionally and with great consideration with letters and phone calls.
Q. HOW DO YOU HANDLE PATIENT BILLING
A. We will bill patients as needed, after we have received settlement from the insurance carrier. If the insurance carrier sends payment to the patient, we advise them with a specially crafted letter detailing all the information we receive from the carrier. We follow up with phone calls until the patient sends in the settlement. If a patient needs to be billed for co-insurance or co-payments, we will do so.
Q. WHAT ABOUT UNCOLLECTIBLE ACCOUNTS?
A. PBA works very hard for our clients and our collection rate runs in the high 90 percentile. Our turn over rate to outside collection agencies never exceeds 6% per year. Our clients make the final determination as to collection action but we only make such recommendations when we feel it is applicable. We honor our commitment to our clients by working as hard as we can to get accounts settled.
Q. IS THERE A DIFFERENCE IN BILLING FROM STATE TO STATE?
A. Yes. Although most states are in agreement with the majority of billing concepts and regulations, there are quirks and variances, from state to state, that can be quite frustrating. They can cost you a lot of time and money if you don't know what you're doing. We are well versed in all billing aspects of New York, New Jersey, Pennsylvania and Connecticut. We can also handle anything that any state throws at us.
Q. HOW IS CORRESPONDENCE HANDLED?
We receive correspondence on a daily basis from carriers and patients. If a carrier has incorrectly denied a claim we respond with the appropriate argument. If they request additional information, and it is warranted, we will submit that information. If it is not warranted, we contact their provider services division to illustrate their error. All correspondence is attended to in an appropriate and timely manner.
important to us. Our fax operates 24/7. Highly qualified staff members pick up the phone and talk to our clients and their patients Monday through Friday from
8am to 8pm. State of the art telephone messaging system operates when
the office is closed.