1. How do we get our claims to you?  We set up a convenient way for your facility to get the information to us, three times per week. Maintain patient demographics, print super bills and get the claims to us immediately. You can fax, mailed (USP “Priority Mail”) or submitted to us electronically through a secure internet connection.

2. Do you transmit claims electronically? Yes, to all Insurance payers that has the capabilities to receive EMC (Electronic Medical Claims) submission. Certain Insurance payers require CMS1500 form to get claims paid faster, due to HIPAA regulation.  Remember, most insurance require that you are credentialed with them for us to be able to submit electronically on your behalf.

3. How quickly do we get reimbursed? The variance of payers and many outside factors make this a difficult question. However, the average turnaround in the industry is 30-45 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 CMMS/HCFA is required to hold the claim for 13 days for all electronic claims and 23 days for paper submissions. Even for commercial payers, 14 days is an exception and certainly not the rule.  The National average for Days in AR (for Family Practice) is 43.

4. Will you also be re-submitting for secondary insurance, tertiary?  Secondary and tertiary resubmissions are included in our service.

5. 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.  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.

6. How quickly can you 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 also like to start at the beginning of the month so that it is easier for you to separate your previous dates of service from the “cutover” dates to PEMB.

7. How do we get our existing patient data to you?  There are 2 options:  1.) A complete printout (or softcopy) from your existing system.  2.) Provide to us the most current patient information as you see them.  This also gives you the opportunity to “start fresh” with your data and have your patients re-register.

8. Should we continue to work our previous billings/collections once you take over?  If possible, we prefer that you continue to work (post payments and re-bill) your existing accounts receivable for a period of three months.  If this is not possible, we can handle that as well.

9. How do I know that you will be more effective than our own office staff? First, one must define billing.  We do more than process claims (see the Service Proposal on home page. Our timeliness claims process is consistent (there no leave, no vacation, no absenteeism of staff).

10. What is your turnover rate for your staff? We have highly dedicated staff that also brings many years of experience.  Because we take a team approach, (where most providers are unable to do internally) we are not impacted when one individual has to leave for vacation, illness or upward advancement in their career path with PEMB.

11. How do I know that my patient data is secure? We have state of the art network in our operations center that backs up all client data several times per day with offsite storage for backups and redundancy. All our staff sign confidentiality agreements. Three requirements (Patient’s name, DOB, SS#, home address or phone number) are required when any information is given over the phone to a patients or responsible parties. Our contract addresses ALL issue pertaining to hipaa guidelines.

12. How often are my claims processed? Within 24 hours of receipt we will prepare your claims for processing.  Obviously, if we need to gather additional information from your practice, we will request for further information, and prepare for processing upon completion of receipt of information.

13. Where does my money go? All payments come directly to your facility.  You then send us the copy of EOBs. 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.

14. I’m new in my practice – 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 allowed fee structure and multiply by 130% or 1.3.  We will continually monitor your reimbursement rates to make sure that you are maximizing your reimbursements with correct fees, and we will provide the appropriate advice when deemed necessary.

15. Why do some billing firms only charge by the claim vs. a percentage of collected revenue? Many new 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.  Frankly, this is something you could do internally.  Most Medical billing firms will charge you a percentage of what they collect. A “win win situation’ we do not get paid until you do.

16. What makes PEMB different from most other billing firms? We have found over the years that we have three strengths that allow us to be competitive and provide us continual referrals from our clients:

A.     Our approach - We take a consultative approach to your business.  Since we come from the healthcare industry we can walk in your shoes and understand and anticipate your challenges as a healthcare provider.  Call it free consulting, call it what you want – we call it added value – value that we love to share with you.

B.     Our experience – We have seen many small start-up billing firms come and go. We have developed many happy clients, our consultative approach and work ethic to make your outsourcing billing a success.

C.    Our fees – We made a decision many years ago that by minimizing labor and real-estate costs (AND Yes, we are still 100% based in the US - no offshore staff), and by providing exemplary quality and experience in billing, we could be one of the most competitively priced firm.