Professional Certified Medical Billing, Inc.
Professional Certified Medical Billing, Inc. is
dedicated to meeting all the insurance and patient billing
needs of your practice. We offer a highly personalized
service, which can meet the needs of most any medical
practice. Our service is specifically designed to meet the
needs of individual and small group practices, our specialty
is in claims processing. Professional Certified Medical Billing,
Inc. carefully balances our client base to ensure each client
will have our complete and undivided attention towards
their billing needs.
We appreciate the demands and sympathize with the
problems of your busy schedule. You shouldn't have to
keep up with the latest Medicare/Medicaid or private
insurance guidelines when you already have the serious
responsibility of running your practice. Our primary goal is
to obtain the largest possible pay-out, for the services
rendered, in the shortest amount of time.
Frequently Asked Questions
Q: What are the different ways to send billing?
Fax - Recommended - fastest and most secure.
E-mail - Faster than U.S. mail, less secure than fax.
Standard mail - Slowest method, also without confirmation unless extra expense in mailing.
UPS/FED-EX - Most expensive in man-hours and costs.
Q: How often should billing be sent?
For the quickest payment and to avoid backlogs, billing should be sent by the end of the following day.
Q: What information is needed to generate a claim?
New Patient Information Form
A copy of the patient's insurance card or WC ID card (front and back)
A copy of the patient's written prescription (if applicable)
The patient's first super-bill (treatment form)
Q: What information is needed, after treatment, to generate a claim?
We must receive a completed super-bill (treatment form) signed by the attending physician, including:
Patient's name
Name of insurance carrier
CPT codes
ICD-10 code(s)
Referring physician's name and the referral #
Any/all applicable modifiers
Q: Should we report insurance payments received in our office to you?
Yes, it is very important we receive this information. All insurance payments
must be accounted for to ensure accuracy of accounts which may have a balance due.
Q: What happens if information is accidentally omitted on required forms?
We send you a notice stating the form is missing required information and will not be
processed by the carrier. This notice is immediately faxed to your office, listing the missing information.
This courtesy check helps avoid missed filing deadlines which are imposed by many insurance carriers.
Q: How do we report payments received from patients, both co-payments and patient billing?
You can report a patient's co-payment, made at the time of service, on their super-bill (treatment form) for
that day's treatments.
You can also report all of the patient's payments, received in the mail, by keeping a Payment Log. A payment log enables you
to report all payments received in your office, using one simple form.
You can report all of the patient's payments, received in the mail, by making a copy of the check and attaching it to their
patient statement remittance (if returned).
Q: How often will patients be billed?
All patients in the system will receive a bill for any balance due, once a payment has been received
by their insurance carrier, if you have contracted for this service. Patients are billed monthly. Payment plans can be easily accommodated.
Q: How do we handle non-payments (denials, etc.) from an insurance carrier?
First, it must be determined if the denial, whether in part or in full, is valid. If the denial
is valid it must be written off. If the denial is not valid, as in many cases, we will request the carrier reprocess
the claim. Unfortunately, many carriers will require that the claim be resubmitted on paper via standard mail,
additional charges may be invoiced to your account as a result.
Q: How do we handle non-payments from a patient?
We will send out no more than three statements, and make one follow up phone call.
After 120 days we recommend the account be turned over for collection and the patient be denied future treatments
until their account has been paid. We strongly recommend an additional fee be applied to each account which has not received a payment within a 30 day period.
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