Physician FAQ


Which types of coding services does PBS provide?

PBS provides CPT and ICD-10 coding services.

Can PBS conduct CPT/ICD-10 coding audits for clients and what does it include?

 Yes, PBS regularly conducts CPT/ICD-10 coding audits for clients as a component of our core service and we do thorough evaluations of CPT/ICD-10 coding in relation to billed services.

If PBS makes coding changes, how are those changes reconciled and communicated with clients?

PBS’s systems are fully transparent, providing clients with real-time access to accounts. Any coding changes are notated, allowing clients to see what patients and third parties are seeing.

Does PBS provide PQRS coding upon billing of claims?

Currently our clients perform PQRS coding internally; however, we can provide custom PQRS reports as part of our service.



Can PBS bill technical separately from professional charges?


Can PBS send client invoices using unique fees?


Can the group format the invoices?

Invoices can be customized. PBS will adjust its processes to accommodate a practice’s processes and procedures.

How does PBS handle hospitals’ refusal to pay a physician group?

First of all, PBS prides itself on recognizing and adjusting our approach with third parties, to include hospital systems. PBS can handle discrepancies and any issues in accordance with a practice’s wishes and tolerances. The goal always is to maximize and expedite revenue, but also to represent the client in a manner that is respectful and business-like.



Which clearinghouse does PBS utilize?

We use Change Healthcare.

How are clearinghouse edits managed?

PBS’s experienced IT department is adept at recognizing and repairing clearinghouse edits.

How often does PBS submit claims?

PBS will adjust the frequency of claim submittal based on the preferences of the client. We can be submit as often as several times a day.

Are PBS’s CCI edits continually updated in the clearinghouse?


Does PBS use other edits in the clearinghouse system to help the process of clean claims?

PBS uses custom edits to clean claims before we send them to the clearinghouse system.

How does PBS handle rejected claims?

PBS reviews rejected claims on a daily basis and follows up accordingly. Always, our goal is to ensure that we limit the exposure of patients as well as to maximize and expedite revenue on behalf of our clients.

What is the average turnaround for PBS from the time it receives billing information from a client to submittal of a claim to the insurance company?

Charges are submitted to the insurance company in real-time.

What is PBS’s strategy for working rejected and/or partially paid accounts?

This is an area of true differentiation for PBS. We pay particularly close attention to every rejected claim, following up to understand discrepancies, filing appeals on clients’ and patients’ behalf as necessary. Our billing specialists are specifically trained to handle these situations and are evaluated on their ability to resolve them.

Does PBS file accounts to secondary carriers through a regular bill cycle?

The regular bill cycle does file accounts to secondary carriers.

Are the accounts automatically filed after first posting?

Accounts are automatically filed after first posting.

What is PBS’s follow-up time on secondary balances without insurance response?

Our typical follow-up time on secondary balances that do not have an insurance response is 30 days.

Will PBS adjust billing cycles based on a client’s request or based on carriers or other criteria?

We will adjust the billing cycle to accommodate just about any factors, including financial class (all BCBS would have the same bill cycle).

For non-hospital patients, some payors will only pay the professional component, while other payors will pay the global fee. Can PBS automatically write off the technical component? Can PBS generate monthly reports that can reconcile these accounts?

PBS will automatically write off the technical component for non-hospital patients and generate monthly reports to reconcile these accounts.



What is the typical self-pay bill cycle at PBS?

We’ll adjust the self-pay bill cycle to accommodate client requests.

Does PBS have the capability to set up and manage payment plans?

We do it all the time. This is an area that sets PBS apart, allowing us to treat patients with dignity and care while maximizing revenue on behalf of clients.

How does PBS monitor payment plans?

Our billing system includes a customized module to monitor patients’ payment plans

Does PBS have the capability to customize messaging based on specific billing cycles?

We do and we encourage clients to do so to provide a customized, personal touch.

Is PBS capable of accepting credit card payments? Are there any exclusions, such as debit cards?

PBS accepts Visa, MasterCard, Discover, and American Express credit card payments and payment with debit cards is no problem.

Does PBS have the capability for patients to make payments online?

Yes we do. This is another way we make life easier for your patients while expediting and maximizing revenue for your practice.

Can hyperlinks to PBS’s online payment system be provided on electronic statements?

Yes, and PBS likewise highlights the availability of online payments on paper statements and in any phone conversations we have with patients.


Does PBS have the capability to post electronic remittances automatically? What is the process for ensuring appropriate parameters are in place for making adjustments?

Yes, PBS can post electronic remittances automatically. Our systems ensure that adjustments are made.

What processes does PBS use to track and verify EFTs?

PBS staff typically has read-only access to client bank accounts. We use billing system and insurance websites to verify EFTs.

Are postings by line item or by account?

Postings are by line item.

How are posting discrepancies handled?

PBS staff ensures that postings balance every day.

What is the process for reimbursement tracking?

PBS tracks reimbursements through our billing system.

What is the process for follow up on any reimbursement tracking that is done?

We verify remittances and report to clients.

How often are the unapplied cash accounts (missing checks, accounts paid to incorrect provider, etc.) reviewed?

Unapplied cash accounts are reviewed and acted upon on a monthly basis.


How often are past-due accounts acted upon?

Once 30 days have elapsed from DOS, accounts receivable are reviewed and acted upon on a daily basis.

Does PBS dedicate teams specifically to work on accounts receivable?

Each client has a dedicated team of billing specialists that is responsible for its accounts receivable.

What is PBS’s process for managing denials?

We dedicate a team of billing specialists to handle everything related to a specific client’s account, including denials.

What kind of follow up do you have on your denial process?

We work denials as far as we can take them, up to and including following up with appeals.

What type of tracking is in place for follow-up and denial situations?

Follow-up, including pursuit of denial situations, are tracked within PBS’s billing system and tracked by corresponding billing specialists.

Are accounts re-aged when they hit the self-pay financial class?


What is PBS’s refund process? Are refunds forwarded to the client for review prior to sending?

PBS refunds are processed monthly after client review.


Does PBS have a specific collection agency that you utilize?

Yes. We work with a group that we trust will treat patients with respect and courtesy.

What is PBS’s threshold for writing off bad debt?

Bad debt is written off after 90 days of no-payment activity.

Does PBS have monthly detailed reports for review before classifying as bad debt?

Each client has a monthly detailed report that may be reviewed before sending accounts to bad debt. Prior review is based on client preferences.



Does PBS provide credentialing as a service?

We do. And we have experienced personnel who are particularly adept in this area.

What is the extra charge for credentialing?

Zero. PBS provides credentialing as part of our core, standard service to clients.

Does PBS have a formal tracking process or software program for credentialing?

Because the credentialing process differs by carrier, by state, and by specialty area, PBS finds the best system is for our staff to track credentialing personally.



Does PBS have the ability to interate with different types of systems?

We’ve yet to encounter a system integration that we have not been able to solve.

Does PBS provide programming services for electronic data files?

PBS has experienced, in-house IT staff to program electronic data files.

Is there an additional charge for programming?

No. It’s a standard component of PBS’s core service to clients.

Will PBS assist a client with programming difficulties?


Does PBS charge for customized reports?

Custom reports can be generated by PBS IT staff at no additional charge.

Does PBS have an IT specialist who will work with a client to ensure integration is set up properly and to trouble-shoot issues?

Each PBS client is assigned a dedicated IT team member. This team member works with the client to ensure integration is set up properly and then to answer any client questions and/or to trouble-shoot any issues that surface.

Does PBS handle any integration issues with hospitals on behalf of clients?


What policy does PBS have in place to review the hospital and LIS interfaces for mapping issues?

A client’s dedicated IT team member will review the hospital and LIS interfaces for mapping issues and work with the client to correct any issues. This is done on a daily basis.

Who repairs the hospital links and assumes the financial responsibility for those repairs?

PBS’s IT staff is responsible for repairing any issues with hospital links. This is done at no additional charge.

Is PBS’s billing system proprietary or is it purchased?

PBS currently licenses Merge Healthcare for client billing and follow up. We are in the process of upgrading to new software. The upgrade will be complete by summer 2018.



How often does PBS update charge masters, insurance masters, and referring physician masters?

PBS currently updates charge masters, insurance masters, and referring physician master on an as-needed basis.

Who would manage our account on a day-to-day basis? How often would you meet with us?

A dedicated team of billing specialists and an IT team member is assigned to every client from the outset. Typically, PBS will meet with clients on a monthly or quarterly basis. If a client wishes, meetings can be more or less frequent.

How often are general billing audits and/or quality-assurance audits performed (if any, outside of the coding audits referenced above)?

Billing and quality-assurance audits are performed on a quarterly basis by an outside consultant.

Does PBS participate in any offshoring?

No. PBS’s entire team is located in our Northern Virginia office, which includes all interaction with clients and patients.

If a practice provides a website for patient questions, would PBS have the capability to monitor and respond to on-line questions posed through this practices website?

PBS staff can monitor and respond to any billing related on-line questions posed through a client’s website.

How long does PBS estimate a total transition would take?

Transition times vary for different clients, but typically all credentialing and integration is complete within three to five months. Client responsiveness will play a large role in the efficiency of transition.

What other efficiencies can PBS bring to a practice?

PBS staff has more than 125 years of combined experience in medical billing. Extensive follow up by this staff maximizes timely collections for our clients.



On which business day of a given month is business typically closed?

We close each month on the third business day of that month for most clients.

On which day can reporting be expected to be delivered to clients?

PBS currently releases reporting ten business days after the end of the month. This can be adjusted based on client request.

Can PBS provide weekly reports or dashboard reporting? 

Dashboard reporting is available to all clients.

Can PBS track the dollars paid back by DOS and DOE? To the month billed? By CPT? By FC? By individual carrier? By date of service?

Yes to all.

What reporting does PBS include in the end-of-month package?

PBS includes extensive reports in the end-of month-package including Aging, CPT, Payer and Doctor/Referring Physician. These reports are also available in the client dashboard.

Is PBS able to track charges, payments, and adjustments by date of service?


Is PBS able to provide reports by referral source and/or location?


Are there additional charges for customized reports?


Can PBS track the dollars paid by hospital in-patients, hospital out-patients, non-hospital patients, by referral source, and by PCCP?

 Yes to all.

How long PBS been in business? 

PBS as an entity has been in business since 2003, but our management team has been engaged in medical billing for decades before that. As a team, we have more than 125 years of experience in the medical billing business.