What services do you offer?
We provide complete Revenue Cycle and Practice Management solutions to Physician practices and clinics for Part B professional service providers.
Do you also offer any customized RCM solutions?
Yes, we provide custom-made services to our clients, If they have any specific requirements pertaining to their billing software, credentialing, authorizations, handling patient inquiries, and more.
Do you have your own billing software?
No, we do not have our billing software, but we provide our clients with third-party premium software for their ease.
Do you also provide other billing software to practices?
Yes, we have a list of various third-party billing software. We can provide you with the billing software you feel most comfortable with.
Will you be able to cater to my patients when they have queries regarding their statements?
We are responsible for all the patient communication whether it is related to billing queries or any other statements.
What reports do I receive?
Being a Medical Billing provider, we will assign you a dedicated manager, Team Lead and team to handle your account. You will receive daily, weekly and monthly statements regarding your practice’s financials, performance, and health.
Will you provide access to the billing system?
We support comprehensive disclosure. You will have complete access to check out our work and generate reports whenever you like.
Do you have any refund process with insurance?
We will contact the insurance provider to determine if the reimbursement request is legitimate. If the refund request is valid, we will try to balance the payments with future payments and let the practice know about it. If the insurance refuses to accept the payments as an adjustment, we will let the practice know, and they can then issue a refund.
How can I start billing for $3?
We’ve designed a simple, low-cost solution to help you start and pave your way to success with $3 billing. You can start billing just for $3, simply contact us at consult@pyramidsglobal.com or 941-260-3111
Prior Authorizations FAQs
Which specialties do you offer your authorization services?
We offer prior authorization services to various specialties such as: (Electrophysiology, Cardiovascular Disease, General Surgery, Psychiatry, Pediatrics, Podiatry, Internal Medicine, Gastroenterology, Dermatology, Family Practice, Mental Health, Counseling, Ophthalmology, Chiropractic, Oncology Radiology, Rheumatology, Urgent Care, Speech Therapy, Physical Therapy, and Occupational Therapy).
Do you let us know if the patient's authorization is about to expire?
Yes, you will be informed when authorization is about to expire. We also keep track of this, starting the prior authorization before it runs out.
How much time does prior authorizations require?
Prior Authorization usually take 7-14 Business Days to process
What happens if prior authorization is denied by insurance?
You can always appeal the denial of your pre-authorization to your insurer if you believe it was made in error. This works best if your practice certifies that the insurance your patient is requesting is appropriate and required for their treatment.
Do you communicate Primary Care physicians for Referral inquiries?
Yes, we do communicate with them for referral request via calls & Faxes and keep follow up on these until it get done.
Eligibility and Benefits Verification FAQs
How will you help in eligibility and benefits verification?
We request the patient’s eligibility and benefits from the scheduler two days prior, send you the benefit information through email, and upload the notes to the EMR system so the practice can view them.
If I want to add more patients the day before or on the same day of the appointment then what?
As soon as more patients are added to the scheduler, we help practices add them within a short period of time.
What transpires when a patient's insurance is inactive or their plan excludes specific services?
We will inform the practice about these concerns so they can get in touch with the specific patient and make the appropriate adjustments.
Medical Coding FAQs
Do you go over medical records and use them to code the claims?
Yes, we go through each medical record pertaining to the services rendered and assign the correct code to process the claim.
What if I want to code the claim on my own and send them to you for review, will you provide such services?
Yes, specific CPT/ICD codes are used to code the claims. Our team then examines the codes and, as appropriate, provides input and review coding compliance and highlights if any areas need to be addressed. We also include the proper modifiers in the claims to ensure compliance and maximize your reimbursement.
Do you use CPT and ICD codes to review the claim denials?
Yes, we do review any denials, make necessary adjustments, and resubmit the claims with proper CPT, ICD, and Modifier.
How much time do you take to code the claims?
We usually code the claims within 24 hours of the practitioner signing the medical records.
Medical Billing FAQs
Will you file claims on my practice's best interests?
Yes, we will handle both your paper and electronic claim submission to the clearinghouse along with the denials management.
Will we have complete access to see the specifics of our payments and claims?
Yes, at your request, the system where you may view your claims and payments will be fully accessible to your team.
Who should we contact with inquiries about billing and collections?
A professional account manager will be assigned to you and will be reachable by phone and email.
Do you send billing and collection status frequently?
Yes, you will receive emails every day assessments of billing and collections.
How frequently do you work on denials and rejections?
Daily work is done on the clearing house, payer rejections, and denials, and a weekly summarized report is presented with the practice.
What reports will you be delivering on your end?
Monthly Financials, Missing claim tracking, Monthly Aging Numbers, Missing information reports, Any other billing report on Demand.
Do you provide patients with statements?
Yes, patients receive statements on a regular basis. The billing cycle can be modified to fit the needs of your practice.
What happens if our patients have inquiries about their bills? Who do they contact?
We have experienced customer service specialists that will help the patients with their inquiries regarding invoices and payments.
Patient Help Desk FAQs
Will you review our patient’s statements and what outcome should I expect from it?
Yes, we review your patient’s statements, the DOS of the procedures rendered, and the outstanding payment pertaining to the patient’s or the payer’s side.
Do you update Coordination of benefits (COB) with payers?
No, we cannot update COB with payers as this can only be initiated by the patients.
How often do you send reminder calls to patients?
Before calling patients with a reminder, we ensure the number of billing statements through mail via clearinghouse with a billing cycle of 28 days are sent as per practice policy. If they don’t reply to the statements, we then call or leave voicemails to remind them to make the payments. Lastly, we compile their statements and give them to providers, who then hand them over to recovery agencies.
What if our patient calls, where is their call routed to?
Yes, your patients can call us from 08 am to 05 pm your time zone; their calls will route to our head office where one of our patient help desk specialists will assist.
Credentialing/Enrollment FAQs
What is the credentialing process and how do I get participating with?
Medical credentialing is verifying and documenting a physician’s qualifications and credentials and ensuring that the information available is accurate and complete within the insurance systems. We will help you contract with top payers in the industry to participate in their health plans.
Which insurance companies do I get my practice enrolled with?
We will ensure you will get enrolled with maximum insurance companies within the state as well as setting up EFTs and EDI.
How much time does credentialing take?
Credentialing usually gets 3 to 6 months purely depending on the availability of insurance panel
What's the process for provider credentialing?
It is the procedure through which a health insurer evaluates the credentials and abilities of a care provider using the given paperwork and the CAQH profile.
What if I want to add a new physicians group to an existing one?
Yes, you can add new physicians to an existing group. All you have to do is provide us with the new list, and we will send it to the insurance company on your behalf.