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

LOST REVENUE Without proper follow up on your claims, you could be losing thousands of dollars and without even knowing it. Without proper follow up on your claims, you could be losing 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 (Certified Professional Coder) credentials? Does your current biller have a LVN coupled with CPC (Certified Professional Coder) credentials? Does your current biller have experience in Risk Adjustment? Does your current biller have experience in Risk Adjustment? Let us take care of your billing needs while you take care of your patients

Primary Billing Solutions… Will research all your insurance claims to determine the reason for denial, non-payment, non-delivery of each claim, through our internal operational strategies of telephone calls to insurance carriers and patients Will research all your insurance claims to determine the reason for denial, non-payment, non-delivery of each claim, through our internal operational strategies of telephone calls to insurance carriers and patients Will appeal all denied claims for reason other than eligibility issues Will appeal all denied claims for reason other than eligibility issues Gets the patients involved to solve carrier issues Gets the patients involved to solve carrier issues Based on above information and our many years of experience, Primary Billing Solutions will correct all necessary claim information and resubmit those claims that we feel has a reasonable chance of being paid at NO additional cost to you Based on above information and our many years of experience, Primary Billing Solutions will correct all necessary claim information and resubmit those claims that we feel has a reasonable chance of being paid at NO additional cost to you

Let us take care of your billing needs while you take care of your patients Healthcare Provider's Top Questions... Healthcare Provider's Top Questions...

Let us take care of your billing needs while you take care of your patients How quickly do we get reimbursed? How quickly do we get reimbursed? The average turnaround in the industry is days. Obviously, some are more and some are less. You may sometimes see different software or billing firms tout “you will get reimbursed in two weeks with our firm!” The average turnaround in the industry is days. Obviously, some are more and some are less. You may sometimes see different software or billing firms tout “you will get reimbursed in two weeks with our firm!” The fact is that Medicare/CMS is promoting EFT (electronic funds transfer) all electronic claims are typically paid out within 7-10 days The fact is that Medicare/CMS is promoting EFT (electronic funds transfer) all electronic claims are typically paid out within 7-10 days Commercial payers are following suite with CMS paying claims within 14 days is an exception and certainly not the rule. The National average for Days In AR (for Family Practice) is 43 Commercial payers are following suite with CMS paying claims within 14 days is an exception and certainly not the rule. The National average for Days In AR (for Family Practice) is 43

Let us take care of your billing needs while you take care of your patients Will you submit secondary insurance, tertiary? Will you submit secondary insurance, tertiary? Secondary resubmissions are included in our service. However, tertiary processing is not. Secondary resubmissions are included in our service. However, tertiary processing is not. The reason: usually one ends up processing a claim for $5.00 and by the time you hear from the tertiary company, the time frame is 6 months which is hardly worth it for the provider. We suggest having the patient pay and then get reimbursed from the tertiary. The reason: usually one ends up processing a claim for $5.00 and by the time you hear from the tertiary company, the time frame is 6 months which is hardly worth it for the provider. We suggest having the patient pay and then get reimbursed from the tertiary.

Let us take care of your billing needs while you take care of your patients What is your average collection rate? First you should define “collection rate”. The “Net” definition is defined as: payments divided by gross charges, minus adjustments. First you should define “collection rate”. The “Net” definition is defined as: payments divided by gross charges, minus adjustments. Our average “Net” collection rate is 90% to 93% of your allowed amounts (based on payer contracted rates). Our average “Net” collection rate is 90% to 93% of your allowed amounts (based on payer contracted rates). The National Average for Primary Care providers is 92% for Net, and 65% Gross collections. The National Average for Primary Care providers is 92% for Net, and 65% Gross collections.

Let us take care of your billing needs while you take care of your patients 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 possible. (This is also dependent upon credentialing if you are a new practice which may take longer) We prefer 2 weeks to ensure the smoothest transition possible. (This is also dependent upon credentialing if you are a new practice which may take longer) We like to start at the beginning of the month so that it is easier for you to separate your previous dates of service We like to start at the beginning of the month so that it is easier for you to separate your previous dates of service

Let us take care of your billing needs while you take care of your patients How do we get existing patient data to you? How do we get existing patient data to you? There are 2 options: There are 2 options: – A complete printout from your existing system of patient information and insurance info – Provide to us the most current patient information as you see them (Pt. information sheet & Insurance card). This also gives you the opportunity to “start fresh” with your data and have your patients re-register, which is recommended annually

Let us take care of your billing needs while you take care of your patients How do we get our data to you routinely? You can have them faxed, mailed (USP “Priority Mail”) or submitted to us electronically through a secure internet connection You can have them faxed, mailed (USP “Priority Mail”) or submitted to us electronically through a secure internet connection We will provide a pick up service once or twice per week (within a 15 mile radius) We will provide a pick up service once or twice per week (within a 15 mile radius) If you choose the electronic method, our software also includes a Scheduling component, which makes it very easy for you to print superbills, maintain patient demographics, and get the data to us immediately on a daily basis. The monthly cost for this method is $225 If you choose the electronic method, our software also includes a Scheduling component, which makes it very easy for you to print superbills, maintain patient demographics, and get the data to us immediately on a daily basis. The monthly cost for this method is $225 With the continuous rise in postal rates and gas, many clients are using this method With the continuous rise in postal rates and gas, many clients are using this method

Let us take care of your billing needs while you take care of your patients How often are my claims processed? How often are my claims processed? Within 72 hours of receipt we will prepare your claims for processing. Within 72 hours of receipt we will prepare your claims for processing. Obviously, if we need to gather additional information from your practice, we will reach out to you for that information, and prepare for processing upon completion of receipt of that information. Obviously, if we need to gather additional information from your practice, we will reach out to you for that information, and prepare for processing upon completion of receipt of that information.

Let us take care of your billing needs while you take care of your patients How do I set my fees and will you assist in watching reimbursements? We advise most of our clients when setting fees initially, or re-setting your fees to work from the Medicare fee schedule for your area and multiply by 130% or 1.3 We advise most of our clients when setting fees initially, or re-setting your fees to work from the Medicare fee schedule for your area and multiply by 130% or 1.3 Medicare fee schedule Medicare fee schedule We will continually monitor your reimbursement rates to make sure that you are maximizing your reimbursements with correct fees and codes, and we will provide the appropriate advice when deemed necessary We will continually monitor your reimbursement rates to make sure that you are maximizing your reimbursements with correct fees and codes, and we will provide the appropriate advice when deemed necessary

Let us take care of your billing needs while you take care of your patients Why do some billing companies charge by the claim versus a percentage of collected revenue? Many billing companies will charge you a flat fee per claim because they are normally only skilled in the initial “transmission or submission” of the claim to the insurance company. This is something you could do internally Many billing companies will charge you a flat fee per claim because they are normally only skilled in the initial “transmission or submission” of the claim to the insurance company. This is something you could do internally Most tenured billing companies will charge you a percentage of what they collect Most tenured billing companies will charge you a percentage of what they collect They are more compelled to work harder, follow through with secondary submissions, denials and work to get you the highest reimbursement possible – a “win-win” for both They are more compelled to work harder, follow through with secondary submissions, denials and work to get you the highest reimbursement possible – a “win-win” for both

Let us take care of your billing needs while you take care of your patients Where does my money go? All payments come directly to your office, unless your current biller is receiving them All payments come directly to your office, unless your current biller is receiving them If you choose we have set up a PO Box for all payments, changing your “pay to” address with each insurance company If you choose we have set up a PO Box for all payments, changing your “pay to” address with each insurance company You then send us the copy of the checks and the EOBs along with your daily super bills / encounter forms You then send us the copy of the checks and the EOBs along with your daily super bills / encounter forms This way we can appropriately track and close the loop on all reimbursement activity This way we can appropriately track and close the loop on all reimbursement activity We scan all of the EOBs for electronic storage and for your future reference should you need them We scan all of the EOBs for electronic storage and for your future reference should you need them

Let us take care of your billing needs while you take care of your patients 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 specialists on staff We have Coders, Nurses, Collectors and Risk Adjustment specialists on staff 90% of billing is billing, no matter what the discipline. The 10% differences tend to be discipline specific nuances 90% of billing is billing, no matter what the discipline. The 10% differences tend to be discipline specific nuances We have experience that is made up of everything from Family Medicine, Internal Medicine, Urgent Care, to Allergy/Asthma to Surgery, Psychiatry, Physical & Occupational Therapy, Chiropractic, Cardiology and Hospitalists, etc… We have experience that is made up of everything from Family Medicine, Internal Medicine, Urgent Care, to Allergy/Asthma to Surgery, Psychiatry, Physical & Occupational Therapy, Chiropractic, Cardiology and Hospitalists, etc…

Let us take care of your billing needs while you take care of your patients How do I know that you will be more effective than our current biller? First, effective billing must be defined First, 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 vacation, no absenteeism of staff), accuracy (we do not send out claims with incomplete data), which generally results in increased cash flow Our timeliness (claims processing), consistency (no leave, no vacation, no absenteeism of staff), accuracy (we do not send out claims with incomplete data), which generally results in increased cash flow The fact that we have Certified Professional Coders (CPC) on staff, as well as an LVN, and experienced Risk Adjustment specialists pretty much guarantees your claims are receiving the best possible reimbursement value than any other service offered to you in the industry The fact that we have Certified Professional Coders (CPC) on staff, as well as an LVN, and experienced Risk Adjustment specialists pretty much guarantees your claims are receiving the best possible reimbursement value than any other service offered to you in the industry

Let us take care of your billing needs while you take care of your patients Ancillary Services Offered Ancillary Services Offered Risk Adjustment Chart Review Risk Adjustment Chart Review Superbill analysis & revision Superbill analysis & revision In-services: In-services: – Front Office Structure Getting the correct information for Optimal Reimbursement Getting the correct information for Optimal Reimbursement – Back Office Structure Time management & Back Office Compliance Time management & Back Office Compliance – Physician Education for Documentation and Coding Credentialing Credentialing

Let us take care of your billing needs while you take care of your patients Questions? (714) (714) fax