More Cash Per Transport
IT'S BEEN PROVEN
The Pridemark Billing Service for years has been providing exceptional customer service and collecting more cash per transport than it’s larger national competitors. Numerous other agencies contract with Pridemark to bill for their EMS services and have seen remarkable results.
The Thornton Fire Department recently enjoyed the news that they were receiving over 40% more per transport than with their previous billing provider. This increase in cash allows for more options for each and every one of our valued customers.
HOW IT WORKS
TRANSPORT / DOCUMENTATION
You do the medical transport and provide the needed medical documentation.
TRANSMISSION
You can send the medical documentation to us via paper, fax, electronic format or secure FTP site.
PRE-BILLING SCREENING
We screen each claim to ensure it is sent to the correct payer. If complete insurance information is not received, calls are made to the patient or the hospital in an effort to gather accurate billing information. Most third party payors now offer access to their databases to verify insurance coverage eligibility. When available, we utilize these services. This assures that we are delivering the bill to the correct payor, the first time, as often as possible.
Based on the information received we will set the appropriate payor and claims will be generated in the proper format based on payor. Our billing software has a powerful verification system which will ensure all the necessary information is captured based on payor requirements prior to submitting a claim. This ensures that claims are not filed without all the information required by a third party payor. This process covers both electronic and paper submissions.
PATIENTS
When the patient is responsible, we work closely with him/her and offer multiple financial options.
MEDICARE / INSURANCES
All Medicare, Medicaid, and commercial claims are submitted electronically. We submit Medicare and Medicaid directly to those payors. The vast majority of commercial insurance claims are submitted via an electronic claims clearinghouse. We downloaded a nightly batch of claims to clearinghouse which then properly formats and submits claims to the payors. As needed we will provide additional required paperwork to Medicare, Medicaid, insurance companies or third party payors.
FOLLOW UP
Follow-up on all open balances is done continually so that claims are paid in a timely manner.
Patients: Pridemark will send follow up invoices to patients as necessary. Our general process for patient billing is as follows:
On trips being billed out directly to the patient, an invoice is generated electronically and mailed through a clearinghouse to the patient. When the first invoice is generated there is also a request for insurance information on the back of the invoice. This is done in an effort to provide the patient with an opportunity to respond with their insurance billing information. If there has been no response from the patient by day 22, a second invoice is generated electronically and mailed through the same clearinghouse to the patient, along with a reminder to contact us if they would like us to bill their insurance. A phone call is made to the patient on day 31 if there has been no response. After day 45, a final invoice is generated. When the account reaches day 60, a final phone call is made and if we are unable to reach the patient, a pre-collection letter is sent to the patient. They have 30 days to respond to the pre-collection letter before the account is turned over to the collection agency.
Medicare, Medicaid or insurance claims: On trips sent out to a third party payor, an electronic file is generated and sent to the payor. If no payment is received within 30 days from the date processed, a follow-up call is placed to the third party payor to confirm receipt of the claim, and that processing of the claim is either complete or underway. If necessary we will re-file with third party payors to obtain payment.
PAYMENT
Pridemark is set up to receive payments from the many sources necessary for EMS billing including cash, checks and credit cards. Upon receipt of payments, each account is posted, reflecting a zero balance or balance due from the patient or supplemental insurance. If required, secondary payors are invoice immediately after payments are posted. The account is then closed or re-billed accordingly. Explanation of Benefits (EOBs) received from payors will then be processed for additional billable payments or denials. Continued follow-up on accounts is done to assure complete resolution, and to aid in timely cash collections.
An important part of providing EMS billing services is the process of cash handling. There are several methods that can be employed. In our opinion, the best option is to utilize a lock box at your bank. When using a lock box, the checks, and the Explanation of Benefits (EOB) are sent directly to your bank. The checks are deposited immediately and the EOBs are forwarded to us for processing and cash posting. A lock box will cost you some additional money in bank fees, but it will eliminate all cash handling by your staff. Pridemark uses a lock box for all of our deposits and it works extremely well.