PLATINUM OUTSOURCE BILLING SERVICE
QUESTIONS/ANSWERS
Do I need to use Platinum System in my clinic to get the Platinum Outsource Billing Service?
Yes, you need to use Platinum System because the Platinum Outsource Billing Service works with the SMART Insurance Management software created by Platinum System and it is linked with client’s Platinum System.
Can I use my own clearing house and get the Platinum Outsource Billing Service?
No, you absolutely need to use an approved clearing house if you want to use our Platinum Outsource Billing Service unless you absolutely need to use another Clearing House for specific payers. Platinum System has created a great business relationship with with our approved vendors and we work closely to make sure our clients get paid the most efficient manner.
Do I have to pay the clearing house fees?
We have different options for the clearing house (see 6% or 7% option) and we have an all-inclusive package where we will take care of the enrollment for you and the package will also include the monthly fee for the clearing house (see 8% option).
What is the rate you charge?
There are three billing options to choose from:
Option 6%: - First three months: 6% of paid claims or minimum of $250 per month
Following months: 6% of paid claims or minimum of $299 per month
Clinic handles all P.I. and non-commercial paper claims
The Doctor is responsible for clearing house fees.
Option 7%: - First three months: 7% of paid claims or minimum of $250 per month
Following months: 7% of paid claims or minimum of $299 per month
All paper claims are included
The Doctor is responsible for clearing house fee.
Option 8%: - First three months: 8% of paid claims or minimum of $250 per month
Following months: 8% of paid claims or minimum of $399
Additional doctors: add $100 per Doctor per month
All paper claims are included
Platinum pays clearing house fee
What is the frequency you will do my insurance billing?
The frequency will depend of the number of claims you have to process per week.
What is the frequency you will do my insurance payment posting?
The frequency will depend of the number of ERAs and EOBs you have to post per week.
Will you do the follow up with our insurance carriers?
We will do all follow up calls with your insurance carriers but the calls requiring medical information from the doctor himself.
What do you mean by PAID claims?
We mean the collected amount.
Is there a minimum charge to use the Outsource Billing Service?
There is a minimum charge of $299.00 per month after three months which represents a little more than $4,900.00 of PAID claims per month with option 6% ($4,200.00 for the first three month).
When does the 6%/7%/8% fee begin after signing the Agreement?
It begins for all payments posted in Platinum after signing the Agreement and also applies to payments posted for past submissions if applicable.
When does the 6%/7%/8% fee end after the agreement ends?
It ends 30 days after termination notice has been received and the last payments posted by our insurance specialist.
Is there a special rate if our Insurance Paid Claims are more than $25,000 per month?
If you receive $25,000 or more in Insurance Paid Claims for a particular month, you will automatically get a 1% discount from your original Agreement.
Is there setup/installation fee?
There is no setup/installation fee but the minimum fee for the first month ($250.00) needs to be prepaid at the subscription of the Outsource Insurance Billing Service Agreement. It will be deducted from the regular monthly fee of the first month (minimum of $250 or 6/7/8% of the Insurance Paid Claims).
Ex.: you subscribe on February 17th and you pay the minimum for your first month ($250.00) on that date. This payment will be used on March 5th. You will resume with the regular monthly payments on April 5th.
Will you do the follow up with our insurance carriers if the payment goes directly to the patient?
If you are a non-participating provider (out of network), it generally means payment will go to the patient. It is appropriate for patients who have paid for their services in full so they may be reimbursed by their insurance. Since the payments and EOBs are not sent to the clinic, we cannot do follow up with your non-participating carriers. However, we will generate insurance claims to accommodate the patient.
If you are a participating provider but does not accept the assignment, there is no guarantee the payments will go to you. If the clinic is not directly receiving the payments, we will unfortunately not be able to follow up on these claims.
Will you do our claims denials management?
To the best of their capacity, our billing specialists will find the reasons for denials and, when possible, they will do all necessary and legal actions to minimize the claims denials. Our billing specialists will notify you if further actions are needed.
Will you do our eligibility checks?
Our billing specialists can check patient eligibility on the clearing house portal for insurance carriers that offer it. The verification is done on demand when we connect to do your insurance billing and payment posting. However, if you need information quickly, it is better to check eligibility on your end through the payer website for more accuracy and no charge. If you want to use the eligibility feature on the clearing house portal you will need to contact them for fees. For clients on 8% option, Platinum charges an administrative fee of $5/month + $0.26 per inquiry for non-participating payer and Medicare.
Do you collect any fees from the personal injury claims we have that are settled between us and the attorney/insurance company?
You can choose to handle your own personal injury claims if you wish.
These claims are usually billed either by statement or superbill by the office. Our insurance specialist is not involved in this submission process. In addition, the transactions are billed without insurance portion so the payments you get from the attorney are posted as a patient payment. We don't collect any fees because our Insurance specialist is not involved in the process.
If the office bills these claims on HCFA forms, you do the payment posting as an insurance payment and our insurance specialist is not involved at all, we don't collect any fees. A special setup will be required.
If you want Platinum System to bill your personal injury claims, we will collect 7% fees. We will also print and mail the chart notes that must be sent along, do the payment posting as an insurance payment and any follow up for denials.
Can we handle personal injury claims in the office but not the commercial paper billing claims?
No, if the clinic chooses to handle in the office its personal injury claims billed on HCFA forms, the clinic must also handle all paper claims.
What happens when HCFA forms need to be used?
When claims cannot be submitted electronically and the clearing house can’t drop them on paper, because the payer will not accept paper forms printed by a clearing house, or SOAP notes must be sent along with the HCFA form, our billing specialists will create a billing task pertaining to HCFA forms to be printed by the office. HCFA forms only need to be inserted in the printer, click on print and mail the forms.
What happens if we do not want to print the HFCAs forms from our office?
If the clinic does not want to be involved at all in the process of printing and sending HCFA forms and other documentation (like the SOAP/Chart notes) that might be required by the Insurance companies, Platinum System can handle these additional tasks. In this particular situation, the rate will be 7% of the paid claims instead of 6%.
The all-inclusive package (8% - see question #3 above) includes paper claims. If the clinic chose to handle in the office its paper claims, the rate remains 8%. However, it will not be applied on paper claims collected amount.
What about the monthly Service Contract I am paying for my Platinum System?
If you are paying a monthly fee for the Service Contract this fee will be canceled as long as you use our Outsourced Insurance Billing Service.
How you will proceed with the insurance billing?
We will connect regularly to your dedicated billing computer (see Mandatory Requirements) to do your claims submissions, post your insurance payments, handle your rejected claims and manage the insurance billing tasks. The electronic claims files will be uploaded to the clearing house portal. In addition, any payers that will accept paper claims from the clearing house, they will drop for the office. If you need to print paper claims in your office our billing specialists will prepare the claims and send them out for you if you choose the option “paper claims” included.
How you will get the information for our patients?
Since we are not part of your staff, we will not communicate directly with your patients to get supplemental information or to validate Member ID or Insurance carrier. However, if there is a need to do so, we will then send a message to the CA with the information missing so she can do it easily. The SMART Insurance Management software greatly simplifies the data entry of the patient insurance information required to submit insurance claims. It works mainly with insurance tasks assigned to different parties so it brings your attention solely to what requires an immediate action on your side. In addition, the SMART Insurance Management software directs you step by step in all aspects involving your input especially with the creation of a new patient file. Indeed, specific screens have been added. If mandatory information is missing, tasks will be added so we are assured to get everything that we need before processing the first submission and to not delay submissions.
When can I start?
If you already use Platinum System in your clinic, if you already have an approved clearing house and if you have a free computer that can be used by our insurance billing specialist we will be able to start as soon as we have your Agreement signed. If you are not currently using Platinum System in your office: The process takes between 30 - 60 days, depending on your cooperation, with data entry and returning necessary information to Platinum and the approved clearing house.
Do you do the insurance billing directly from our Platinum System?
Yes and no. We have created the SMART Insurance Management software to simplify the data entry of the patient insurance information and to generate insurance tasks when information is missing or wrong. It is closely linked to Platinum System used in the clinic. The insurance billing information is exchanged in real time between SMART software and Platinum System. Our insurance specialists will generate claims submissions through Platinum System as well as payment postings. But the insurance billing management will be done through the SMART Insurance Management software as well as the entry of the insurance information.
Will I be able to follow my submitted claims?
For sure, you will get all your reports in real time and whenever you want it. Our insurance specialists will also be available to provide you further detail or specific insurance case information as you need it. The SMART Insurance Management software includes a great Message Center allowing an easy communication between the office and our insurance specialists.
How you will take control of my system to do the billing?
We will need to have access to a dedicated insurance billing computer in your clinic. This computer needs to be free at all the times so our insurance specialists can handle insurance information validation, insurance claims submissions, insurance payments posting in transactions ledgers, follow up with insurance carriers, claims denials management, etc. If you have a dedicated server and this one is not used by your staff, we could also use it. On the dedicated insurance billing computer (or free computer), we will install Remote Utilities or equivalent software in order to access your Platinum System by ourselves. So, we don’t need to contact you each time we want to connect to process your insurance claims. Again, this computer can only be used by your Platinum System Billing Specialist.
What happen if I refer a new client for the Outsource billing service?
If you refer a client to the Outsource Billing Service we have a referral program where the client who refer will receive a twenty-five (25%) percent discount with a max discount of $500 off the following month's invoice, upon signing up a Billing Service Agreement between PSCR and every new client referred by the Client (Referral will be paid after new client has been in the billing program for 3 months).
Who will respond to insurance carrier notes request?
Our billing specialists will respond to insurance carrier requests to get patient SOAP notes if we handle your paper billing claims. Otherwise, we will pass to you the request.
Who will turn off insurance coverage when exhausted?
You will receive a billing questionnaire that will be used to establish the basic rules. Our billing specialists will act according to the answers you will provide to each question. If there is an exceptional situation, you will be consulted.
Will you read insurance carriers emails and bulletin?
All emails and bulletin sent by insurance carriers can be forwarded to our billing specialists. We will read them cautiously and will convey you all information that requires your prompt attention.
Will you attend to insurance carriers webinars?
Yes, our billing specialists will attend to webinars if needed.
What to do with checks and paper EOBs mailed to the office?
If you receive check and paper EOBs by mail, you will need to scan them and place a copy in a specific folder. We will take care of them.
MANDATORY REQUIREMENTS
The Outsource Insurance Billing Agreement must be completed and signed by the clinic and received by Platinum;
A dedicated computer for the billing must be free all the time, preferably the server;
If the billing computer is not the server, you must ensure it connects to the network at a speed of 1.0 Gbps or over
You must allow Platinum to install Remote Utilities to access the billing computer;
You must be enrolled with the approved clearing house* including paper claims and Electronic Payment Remittance (ERA);
If you choose to handle in house your paper billing claims (P.I. Cases and other), the clinic needs to have HFCAs in hands and printer ready to be used;
A scanner must be connected to one of the workstation to scan patient's’ insurance card and paper EOBs.
* See question 2 for details.
I have read and I understand the document Outsource Insurance Billing – Questions & Answers and I want to go ahead with the Outsource Insurance Billing Agreement.
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