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SERVICES

BILLING

ProClaims services each account according to guidelines established by each individual client. Guidelines include, but are not limited to, the services billed for, the amount charged for said services, whether residents and non-residents are billed alike, the number of invoices sent to each patient, and whether accounts will be turned over to a collection agency. Our business practice is to work with the patient on behalf of our client, or their responsible party, to obtain all information necessary to collect from the patient’s insurance. In cases where the patient has a co-pay, deductible, or has to pay the entire amount, ProClaims will work to make this collection as easy as possible. With permission of our client, ProClaims will suggest monthly or weekly payments, or in cases of financial hardship, guidance on how to handle the balance of the bill. We understand the relationship between you and your patients and residents, and will work hard to maintain your fine reputation.

Each client is assigned a primary billing representative as a point of contact. All billing representatives are kept current with Medicare and Medicaid policies and procedures through seminars, newsletters, and information provided on Medicare and Medicaid web sites. ProClaims also retains a nationally recognized Medicare consultant, who, among other provided services, holds on-site reviews to ensure billing practices are current and accurate. In addition, annual meetings are held at our individual client’s office for a review of their account. General meetings, when warranted, are scheduled at ProClaims’ offices to advise all of our clients of any changes in Medicare and/or Medicaid billing procedures, or for any other mutual needs.

ProClaims complies with all HIPAA rules, regulations and requirements, and all ANSI requirements ProClaims will execute a Business Associate Agreement for all clients to maintain compliance with the law.

CLAIMS


All claims are filed electronically to Medicare, Medicaid, and any and all major insurance companies that accept electronic filings, which expedites payment. If insurance companies do not accept electronic filings, claims are filed on paper (HCFA1500 forms). Patients without insurance, or those whose trip sheets contain incomplete information, will receive invoices in an attempt to gather the needed data, or for payment by the patient.

COLLECTIONS


ProClaims does not negotiate any monies for our clients. All monies collected will be remitted to the client via a third party operated lock box. ProClaims will not have access to, or control of, any funds received by the client.

ProClaims does not act as a collection agency for our clients. ProClaims will forward all uncollectible bills to the client for its decision on collection action, and will provide any information requested by the client, or their designated collection agency, to make the collection process as easy as possible.

TRAINING


Training and education as to proper documentation of an ambulance run report is essential to successful billing and collection. On-site training will be initially provided for EMS personnel, if so requested, and ProClaims’ billing and education staff are available for ongoing training in addition to both telephone and personal conferences as needs arise.

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ELECTRONIC PATIENT CARE REPORTS

ProClaims will work with you to import your patient care reports from any Electronic Patient Care Reporting program. We have worked with ImageTrend, Code Red, and Zoll.

Additionally, ProClaims has established a working relationships with Zoll Data Systems, and Code Red. We also offer the Zoll Tablet PCR program to our customers, if they choose to use the ZollData Systems program. With a laptop computer on each of your ambulances, you will be able to capture all of your patient care information in an easy to follow and efficient format. Information can be sent for review as soon as the trip is complete, and data can be transmitted for billing as early as the day the trip is run.

Electronic Patient Care Reporting uses tablet computers for fast, simple, accurate touch screen technology that will increase efficiency by:

  • Preventing incomplete patient care reports
  • Eliminating inefficient paper processes
  • Ensuring protocol is followed consistently
  • Providing the ability to import statistics from cardiac monitors
  • Streamline QA/QI, and Reporting

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Frequently Asked Questions

Are there any set up fees? No. all costs of set up are included in the monthly charges. This would include tablet software and the tablet PCs as well, depending on your needs and requirements.

Are there any charges other than the monthly percentage. No. All costs are covered in the monthly fee. There are no additional charges for items such as postage, stationary, office supplies or any other expense.

Why do you charge a percentage and not on a per claim basis? It is ProClaims’ opinion that charging on a percentage of revenue collected basis give us added incentive to do our best for you. Where is the incentive to collect your money, do the extensive follow-up often required, if we have already been paid because we processed a claim. We would rather work harder and collect more funds for you because it is not only better for us, but better for you as well.

Are you HIPAA compliant? Yes, ProClaims follows all of the guidelines required to be compliant with HIPAA (Health Insurance Portability and Accountability Act) rules and regulations, as well as all Federal and State laws.

Will you assist us with paperwork? Yes, if you do not have the necessary Insurance IDs, NPI number or any required documentation to collect your funds, we will complete it for you or work with you to get the proper forms and information where it has to be.

What about training? ProClaims will come to your offices to train your crews on the proper completion of trip sheets to make the billing process go more smoothly, and to help your staff understand the importance of complete and accurate documentation. If you are using an ePCR program we will work with you to develop “closed call rules” that capture all the information needed for billing before the medic can close out the transport.

How do you stay current on changes in the industry? Our staff and management attend seminars and training sessions to remain current. Additionally, ProClaims retains the services of a nationally recognized Medicare Billing specialist who reviews our claims on a regular basis for best practices billing procedures.

How about Electronic Patient Care Reporting, do you do this? ProClaims will work with you to set up the most convenient way for to you to transmit data from your ePCR program to us. We currently work with ZollData, Code Red and ImageTrend.

Additionally, if desired ProClaims can work with you to help you acquire an ePCR program and will work with you to have the cost become part of your monthly fee so there is no upfront cost to you for software.

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Electronic Patient Reports

Frequently Asked Questions

911 Holly Hills
St. Louis, MO 63111

Phone: 314.633.3900
Faz: 314.351.9935

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