Q. How do you charge for medical billing services?

A. Our fees are based on a percentage of payments collected, and are all-inclusive—there are no hidden charges.  For full-service billing, this fee generally ranges between 5% to 10%, depending on the specialty, payer mix, and practice revenue. Larger specialty groups may pay even less.  For past account receivables (Old A/R) that need to be collected, this fee generally ranges between 25% – 35%, depending on the age of the claims. 

 

Q. Are you HIPAA-compliant?
A. Yes, Tri-City Physician Services is fully compliant with all HIPAA requirements and standards.

 

Q. Where do the insurance checks go?
A. Payments are always sent directly to your practice or to a designated lock box account—never to us. Be wary of billing companies that demand that the payments come to them. All we need is a front/back copy (or original, if you prefer) of the EOB to properly credit the account.

 

Q. What kind of service will you give me? 
A. We’ll give you excellent service—we take pride in our outstanding customer service, extreme attention to detail, lightening fast response, and personal follow-up. 

 

Q.  What kind of information do you need from my practice?
A. To make things easier and more accurate, we’ll design an easy-to-use superbill for you, or work from your existing one. In less than 30 seconds per encounter, you’ll be able to get us the information we need to properly submit your claims. (For new patients, or patients whose demographic and insurance information has changed, we ask that you give us a copy of their registration sheet and copies of insurance cards).

 

Q. I’ve seen medical billing software for sale. Why shouldn’t I do my own billing?
A. The answer to this question depends on the specific needs of your practice. In some cases, it does make more sense to do some or all of the billing in-house and in that situation we can easily get you onto our software program, Practice Manager X3.  That’s why we carefully evaluate your needs and advise you accordingly. We will not try to sell you something you don’t need.

 

Q. Who does the patient call with a billing question?
A. Our number is printed on your patients’ statements and a Billing Specialist will handle all billing questions.

 

Q. What kind of reports will I get?
A. There are a variety of reports available.

The standard report package includes comprehensive monthly closing reports that confirm productivity such as the amount of charges, insurance payments, patient payments, and aged receivables. Practice-specific reports are usually available on request, as well, and can greatly enhance your ability to make fiscally responsible business decisions.

 

Q. Are you a collection agency?
A. No. We focus strictly on billing and follow-up. However, we pursue delinquent insurance claims and continue to work on them until payment is received. Our procedure is to send three statements to patients. If after the third statement there is no response, we send a 10-day notification letter. At that point, it’s up to you to decide how to pursue collecting the balance due (e.g., outside collection agency, bad debt write-off).

 

Q. What if the patient is on a payment plan?
A. We’ll send as many statements as it takes to get the balance paid as long as there is patient activity on the account.

 

Q. What’s included in your services?
A. Our services include the following.

Help with transition to new billing service:

 

- Implement/integrate Practice Manager X3

                                                                         

- Assist with documentation necessary to sign up new providers to various carriers.

 

Review demographic and insurance data and encounters/superbills received from you to ensure accuracy (e.g., CPT coding, modifiers, diagnoses linkage), and enter them within 2 business days.

 

Report and request any missing billing documentation to you. We expect a reasonable turnaround time (usually 48 hours).

 

Assist with CPT, ICD-9, and HCPCS coding to maximize reimbursement and minimize denials.

 

Electronically bill all payers.

 

Handle third-party billing.

 

Resubmit claims for review when initial payment is not in line with typical doctor profile (we will maintain Managed Care contract profiles to assure proper reimbursement, as we recognize this to be a critical factor in maximizing collections).

 

Post payments received to patient accounts (line item application allowing tracking of CPT reimbursement history).

 

Post Adjustments according to provider’s Managed Care contract profiles, monitoring the profiles for reimbursement accuracy as outlined above.

 

Send monthly statements to patients and follow-up non-payment by phone and mail.

 

Review all claims within a 30–45-day period and resolve denials or resubmit claims as necessary.

 

Submit and review the provider’s monthly reports (a wide range of already-developed custom reports is available). Some of the standard reports include:

 

- Practice financial summary by doctor/location with charges, payments, adjustments (detail categories) with collection ratios and A/R totals,

 

- Summary/detail/analysis aging reports by insurance and patient due,

 

- Detail/summary procedure and diagnoses productivity reports,

 

- New-patient-visit count by doctor/location, with financial detail,

 

- True collection history reports by doctor/location/CPT/ICD-9 and other selection criteria,

 

- Additional payer-specific productivity reports to analyze Managed Care contracts’ profitability and utilization.

 

- Review past-due accounts with the physicians or their designee for further action (reports can be provided by doctor and patient name, with collection history, to facilitate the doctor’s or practice manager’s decision-making process).

 

- Advise physicians on any changes in HCFA requirements, CPT, and ICD-9 coding to maximize their reimbursement, and

 

Assist in fee schedule review/updates annually (automated fee/profile schedule updates).