This is information straight from the training manual of a very well respected billing company: Physicians World Online, Inc.  This is what they provide their sales representatives to help them gain an understanding of the billing process and why each element of it is so important for the overall sucess.

This process is for those clients utilizing our billing service and PM Software

v Set-up account with PWO’s clearinghouse: We gather the necessary account set-up information, including Physician’s names, Tax ID’s, PIN #’s, passwords and usernames and input them onto a secure network using advanced encryption technology.  Written confirmation for your NPI and Medicare Group and Individual numbers.

v Convert data to PWO’s billing software: If the client prefers to save their old data then we can convert the existing data from their current medical billing software and transfer to our program.  We prefer our clients to use our practice management/billing software but we can also work with their current system if they do not wish to change.  There is a separate nominal one-time charge for the data conversion. (Not available for all programs)

v Set-up computers for remote access and file-transfer system: Our medical billing service provide the physician with full access to all of their billing information. Your Account Executive will come to your office and configure your office computer to access your billing information. We then install a file-transfer system, so you can electronically transfer your files (superbills, EOBs, etc.) to us.

v Provide training to office staff on basic use of scheduling/billing system: You and your office staff are trained on how to use the billing/scheduling software.  The administrator is trained on how to access and utilize the reporting module.  Additional assistance is always available for technical support.

v Custom Training Program Developed for those Clients utilizing EMR

v Determine requirements for financial reports: Our medical billing service offers a variety of financial reports based on your needs. You will be trained on the selection of available financial reports and we will determine which reports you are interested in receiving. You can also print your reports at any time.

v Coordinate roles and responsibilities: Your Account Executive will sit down with you and your office staff and coordinate the roles and responsibilities on both sides. We handle the entire process for you, leaving you free to concentrate on your practice. Once your system has been configured and installed, our medical billing specialists provide you with the following complete medical billing services on an on-going basis.

v Enter patient demographics: This can be performed by our staff or remain as part of your current procedures.

v Enter charges for office visits and procedures: We enter all superbills/encounter forms into the medical billing system.

v Transmit electronic medical billing claims and/or mail paper claims:  We transmit medical billing claims electronically where possible. If the medical insurance company doesn’t accept electronic claims, we print the claim and mail it to the insurance company.

v Receive audit reports within 24 hours of electronic medical billing submission: Our medical billing software receives audit reports from the clearinghouse with notification of errors or omissions in the claims.  We will send you a list of claims that need your attention.  It is important to have someone in your office to handle these inquiries.

v Notify your office regarding “incomplete medical claims” that did not process: We notify your office immediately if claim information is incomplete. Once your office submits amended claim information to us, we resubmit immediately.

v Follow-up with insurance companies on unpaid medical billing claims: If an EOB has not been received within 45 days of the initial billing date, we will follow-up with the insurance companies after that period. For Medicare claims we will call if an EOB has not been received in 20 days.  As for claim denials, our medical insurance contact specialist reviews the EOBs and subsequently initiates follow-up calls with the medical insurance companies, contacts your office in the event of missing information, or bills the patient.

v Balance bill patients: Three Statements and a phone call are sent to the patient in a 120-day period: After 180-days, we send your office a patient aging report and you can decide how you would like to proceed.  We can submit the patients to our collection agency or you may wish to submit them to your own agency.

v Enter and reconcile insurance and patient payments: We post all payments that are received by your office. Checks are sent directly to your office and your office staff is required to send the copy of the EOB or check to our office so our medical billing specialists can post the payments to our medical billing system.

v Provide monthly financial reports: You have a vast selection of financial reports to choose from. Based on your initial selection of the reports you would like to receive, we send you those reports monthly. If you need additional services such as reports, your Account Executive will go over those needs with you at any time.

v Hold regular meetings with Account Executive to review medical billing and collection activity: At your discretion, we encourage you to meet with your Account Executive on a monthly basis. He/she will sit down with you and discuss the specifics on your account, and will help you get the most out of our unique medical billing services.

v Review medical billing fee schedule: Our Service includes a complete Free Evaluation of your fee schedule to fully understand your charges versus typical payments by various insurance companies.

Physicians World Online is a Medical Billing and Health Care service company based out of Jacksonville, Florida.