Practice staff utilizes the appointment scheduling system to enter patient appointments and collect very basic demographic information. The system displays co-pays, and any outstanding patient of family balances at the time of scheduling so staff members can provide the patient with a friendly reminder of amounts due at the time of service. On the day of the visit, the system can pre-print paper charge slips, or interface appointment data with an Electronic Medical Record system, depending upon your practice setup and desires.

On the day of the visit, the physician simply "checks off" the service and diagnosis codes for the visit using the charge slip.

Not your choice? You also have the choice of a Electronic Medical Record system. Please call for further details.

In the case with EMR, data is automatically transferred electronically to PRMS for billing purposes on a real-time basis. Nothing else needs to be done by the physician staff.

Sticking with paper charge slips for now? That's OK too. Paper charge slips may be sent to us in a number of ways including scanning, faxing, mail or courier. Whatever works for you will work for us!

PRMS reimbursement specialist compiles and review the data provided by the practice, enter the information into the system and generate a claim. We can also verify insurance information prior to submitting the claim which eliminates denials. Batches are balanced and reviewed by our specialists, after which each claim is "scrubbed" for errors using an advanced system module known as the Claim Scrubber. There are literally thousands of checks performed, such as CPT/ICD9 validation, date validation, LMRP and payer specific edits. We also create our own edits depending on the specialty of the practice.

PRMS now transmits the claims to the various payers for reimbursement. Most insurance companies except electronic claims. If, for some reason, the claim cannot be submitted electronically, a paper claims is generated and mailed. After submission, the clearinghouse and paper will perform additional edits which are relayed back to our reimbursement specialists.

Insurance payments are received via either paper or electronic remittance ad vices. Payments can be received at either the practice location (which are then forwarded to us for processing) or through the use of a bank lock box. The practice can also choose to have the payments sent to the PRMS lock box. PRMS then obtains a scanner from your banking institute and electronically deposits the insurance checks directly into the clients account.

Once received, payments are typically reviewed; line-item posted in the system, compared against fee schedules, and then balanced. PRMS reimbursement specialists post, review, research, correct, and re-process or appeal any denials or underpayments.

Here we go! Billing isn't as simple as just sending out a claim. Even when a claim is paid, patients often carry a second insurance, requiring the balance from the primary claim to be submitted to a secondary payer. Even on a perfectly clean claim, it can take multiple claims or patient bills to get you paid appropriately. PRMS takes care of all this for you without disruption.

Perhaps the insurance payer has paid their portion and the balance is due from the patient. Or, maybe the patient never had insurance. Either way, PRMS performs all patient billing functions for your practice. Should the patient fail to respond, a letter and/or call sequence is initiated to obtain payment. It is important to note that patients are provided with a toll-free number to call with any questions about their bill. These calls come to the main office of PRMS where they are answered as your billing office.

PRMS is not a collection agency, and there4fore our letters and calls are structured in a way which encourages your patients to work with us to resolve the balance. This may mean setting up a budget plan or other mechanism which ensures you not only get paid, but also retain the loyalties of your patient base. However, should a patient refuse to work with us, then we can facilitate the transition of a balance to an outside collection agency for payment. We always treat your patient with courtesy and respect.

Throughout the entire revenue cycle process, PRMS incorporates an advanced series of both internal and external checks and balances. This helps ensure that every patient seen has been billed, every procedure is accounted for, every dollar balanced, and every outstanding claim gets follow-up on.

Here at PRMS we believe that peace of mind should come standard.

Here is a dirty little secret. Even though a practice may submit a perfectly clean claim to an insurance payer, there is no guarantee that it will get paid, or that it will even be acknowledged with a denial. Couple this with the fact that payers have more and more stringent rules, systems and loopholes aimed at not paying providers, and there is a very good chance you may never get paid on quite a few of the valuable services you provide to your patients.

PRMS fights fire with fire. How? Well, without giving away all of our secrets, we can tell you that we have systems that aggressively detect unpaid or mis-adjudicated claims. These systems are structured on a rules-based, insurance-specific engine and determine when an outstanding claim should be brought to the attention of one of our Reimbursement Specialists for active follow-up procedures.

Most practices doing billing in-house lose a tremendous amount of money through the cracks without even knowing it. PRMS proactive follow-up protocols help seal these cracks. After all, it is your money, and you deserve to get paid.

The systems mentioned in the previous step do a great job at identifying outstanding claims and giving us the information we need. However, technology alone does not get claims paid. This is where our experienced staff come into play (again).

Once a claim has been identified as past due, the system alerts our team who then review the history and follow-up on the claim accordingly. This usually means making calls to the various payers and getting into the nighty gritty details required to get the claim paid, and not accepting "the check is in the mail" answers. Not just follow-up but resolution.

Our services extend beyond just performing bill and reimbursement functions, they also produce an extraordinary amount of data regarding your practice which can be used to analyze your practice and keep it moving forward in the right direction. It starts with our summary reports which provide snapshots of key performance indicators concisely on one page, without having to go to the back page of numerous different reports. We truly believe you cannot improve what you can't measure.

PRMS's reporting provides you with an intelligent presentation of important information necessary to make your practice as successful as possible.