FAQ

What sets you apart from other medical billing companies?

Specialization. In the face of the teeth gnashing complexities of our reimbursement system, we recognize that we can only be the best at our work by focusing on only one discipline.

We work only with pediatricians and we use exclusively pediatric-specific tools and software.

We understand the unique needs of pediatricians – the high volume, the complex family billing arrangements, the tight margin – and how important our work is to keep your practice viable.

Additionally, as pediatric billing specialists, PedsOne is unencumbered by the temptation to sell you an EHR or practice management consulting services because we don’t offer those products and services.

One service, one specialty, one system, all pediatric specific.

How does it work?

PedsOne picks up the charge in the system as the practice enters it. Our billing staff conducts an initial review and verification of the charges. Once the charge has been scrubbed, PedsOne submits insurance claims to the appropriate payers. All claims are submitted electronically, except for those payers who do not accept electronic claim submissions or appealed claims that require additional documentation.

Reimbursement specialists promptly follow up on claims when payers fail to adjudicate within the specified time frame. At the same time, PedsOne researches denied claims, re-files and updates the practice’s internal database to alert staff to changes in payer requirements.

PedsOne has immediate online access to information requested by payers. This helps expedite claims adjudication with minimal interruption to the practice. Once payment is received into your financial account, we match it to the charge and post it into your account. PedsOne then allocates payments, denials and denial codes, and determines appeals on payment that vary from negotiated contract to actual insurance payment.

Our team of reimbursement specialists follows every claim from submission to adjudication, ensuring proper handling of each submitted claim. Claims status is tracked online and in real-time for continued reimbursement management. Claims submission dates, re-filing, as well as follow-up billing and collection notes are recorded and monitored by the PedsOne billing staff.

Acting as the main contact for your patients regarding their personal balances, we generate weekly patient bills and monthly statements and make past due reminder phone calls. PedsOne answers patient billing related questions and work in a firm but flexible manner to create reasonable payment plans.

Is outsourcing my billing to PedsOne better than keeping it in-house?

It depends. If:

  • You have knowledgeable, expert staff;
  • your staff will stay employed at your practice for a long time;
  • your practice meets or exceeds standard benchmarks for key measurable such as AR Days, aging, and revenue per visit;
  • you practice in an area where it is easy to find experienced loyal billing professionals and you offer a strong salary and benefits package;
  • you don’t mind the headaches of medical billing and managing the staff;
  • you run the billing on industry leading software and up to date high-end hardware in a consistently secure efficient IT environment;
  • you have the capital to buy billing related equipment and supplies and;
  • you have the time necessary to get the billing process up to speed (hire, train staff, set up the system, connect with payers, set up ERA, EFT, etc.).

…then keeping billing in-house may be the best move for you. If this is not the case at your practice, then outsourcing your billing might very well be right for you and you should give PedsOne a call.

My last experience with a billing service left me with 59 days in AR and a 15% drop in my monthly revenue. How can I be sure with PedsOne that I am getting the specialized expertise my practice deserves?

Most billing services are generalists- they bill for all specialties and it is no secret that pediatricians often fall quite low on their priority list.

Here at PedsOne, we bill for only pediatrics. In addition, every employee is an AAPC Certified Pediatric Billing Specialist or well on their way of becoming one.

But don’t take our word for it, call our clients and vendors and ask them what they think of us. We believe successful medical billing requires significant depth and breadth of knowledge assets – coding, claims processing, payer specific directives, personal collections, financial expertise and critical problem solving skills.

What system will you and my practice use for the billing and practice management?

We use the award-winning, pediatric-specific billing and practice management software from PCC (pcc.com). PCC’s system includes clinical tools – like the most sophisticated pediatric recall tool on the market – and a practice dashboard tool featuring a pediatric benchmarking tool unique to the industry.

Unlike other billing systems, however, we don’t hold the contract for your software. Other billing systems control your data and your practice management tools, holding you hostage and making it difficult to leave them. All PedsOne clients have the added benefit of being distinct PCC clients as well, taking advantage of their 24/7 guaranteed support.

Will you do my billing using the software system I already have?

If you use PCC’s Partner system, we would do your billing for you however, we work exclusively on the Partner system because we feel it is the best pediatric billing system on the market and being expert on one system is part of the PedsOne formula for success.

PedsOne charges more than my old billing service. Comparatively, how expensive are you guys?

More expensive than some, less expensive than most is what you might find after looking around the market. As it is with computers, cleaners and car mechanics, most of the time, you get what you pay for. If you are like most other health care practices, there is much more opportunity for enhancing your revenue than in reducing your expenses and you are already running a very lean business. It is not uncommon for PedsOne clients to afford our rates several times over with the increases in revenue we achieve. Many billing services fall short of doing full collections or leave the hardest follow up work to you. At PedsOne, we get the challenging claims paid and that makes all the difference for you financially.

What does your rate include?

Many other billing companies charge for paper, stamps, etc. Not PedsOne. Our fee is all-inclusive.

How long will it take to transition my billing to PedsOne?

We like to do things one way: the right way, so the ever critical transition usually takes between 60 and 90 days. It depends on the complexity and urgency of your situation.

How is your relationship with your software vendor?

Rather than the typical autonomous and distant relationship between billing service and billing system vendors, PedsOne and our billing system vendor Physicians Computer Company (PCC) have developed a cohesive working collaboration (we went so far as to place our office in the same building as theirs). The result is greater support, more economical pricing and increased efficiency. PCC and PedsOne will “tag team” PedsOne billing clients with support from a variety of areas. This model allows us to operate in an efficient, fast and highly responsive manner.

Are you able to serve my practice from five states away?

Yes – we can do it from 12 states away! It is as though we sit down the hall from your office.

We connect with our clients very frequently, usually multiple times throughout each day, via phone, email, chat, skype, on-line meeting, fax, scan, and good old fashioned mail.

With a steady stream of information flowing between your practice and PedsOne, we fix coding problems, answer billing questions, offer suggestions to improve your revenue cycle, give you a heads up on the new Medicaid coding guidelines, help your front desk enhance the check-in process, and a multitude of other services. With our custom reports and the PCC Dashboard, we provide you data by which to assess the status of your practice- from revenue per visit to the number of 5 year old’s who are late getting in for their well child visits.

Do you do my personal billing?

Yes, PedsOne handles all insurance and personal billing with specific time-tested protocols. We work closely with your staff to ensure that patients and families are treated with respect.

What if I’m not sure?

Our complimentary financial analysis includes a practice questionnaire and an initial telephone conference to discuss your financial position. PedsOne will then use the Partner System to investigate your collection effort, coding habits, insurance mix, recall effort, and/or other financial or business efforts.

What kind of reporting and support do you offer?

The PCC Partner system provides an industry leading variety of insightful reports with which to analyze and manage the practice’s’ revenue cycle. PedsOne helps our clients create, run and interpret these reports and works with providers and managers to develop improvement measures based on trend data. Our aim is to develop a very consultative working partnership with your practice. Our clients appreciate our willingness to go well beyond billing in support of their practice.

PedsOne Terms of Service Privacy Policy

1. Terms

By accessing the website at http://www.pedsone.com, you are agreeing to be bound by 
these terms of service, all applicable laws and regulations, and agree that you are 
responsible for compliance with any applicable local laws. If you do not agree with 
any of these terms, you are prohibited from using or accessing this site. The materials 
contained in this website are protected by applicable copyright and trademark law.

2. Use License

Permission is granted to temporarily download one copy of the materials (information 
or software) on PedsOne's website for personal, non-commercial transitory viewing only. 
This is the grant of a license, not a transfer of title, and under this license you 
may not:
- modify or copy the materials;
- use the materials for any commercial purpose, or for any public display (commercial 
or non-commercial);
- attempt to decompile or reverse engineer any software contained on PedsOne's website;
- remove any copyright or other proprietary notations from the materials; or
- transfer the materials to another person or "mirror" the materials on any other server.
This license shall automatically terminate if you violate any of these restrictions and 
may be terminated by PedsOne at any time. Upon terminating your viewing of these 
materials or upon the termination of this license, you must destroy any downloaded 
materials in your possession whether in electronic or printed format.
3. Disclaimer

The materials on PedsOne's website are provided on an 'as is' basis. PedsOne makes 
no warranties, expressed or implied, and hereby disclaims and negates all other 
warranties including, without limitation, implied warranties or conditions of 
merchantability, fitness for a particular purpose, or non-infringement of intellectual 
property or other violation of rights.
Further, PedsOne does not warrant or make any representations concerning the accuracy, 
likely results, or reliability of the use of the materials on its website or otherwise
 relating to such materials or on any sites linked to this site.
4. Limitations

In no event shall PedsOne or its suppliers be liable for any damages (including, 
without limitation, damages for loss of data or profit, or due to business 
interruption) arising out of the use or inability to use the materials on PedsOne's 
website, even if PedsOne or a PedsOne authorized representative has been notified 
orally or in writing of the possibility of such damage. Because some jurisdictions 
do not allow limitations on implied warranties, or limitations of liability for 
consequential or incidental damages, these limitations may not apply to you.

5. Accuracy of materials

The materials appearing on PedsOne's website could include technical, typographical, 
or photographic errors. PedsOne does not warrant that any of the materials on its 
website are accurate, complete or current. PedsOne may make changes to the materials 
contained on its website at any time without notice. However PedsOne does not make 
any commitment to update the materials.

6. Links

PedsOne has not reviewed all of the sites linked to its website and is not 
responsible for the contents of any such linked site. The inclusion of any link
 does not imply endorsement by PedsOne of the site. Use of any such linked website
 is at the user's own risk.

7. Modifications

PedsOne may revise these terms of service for its website at any time without notice. 
By using this website you are agreeing to be bound by the then current version of 
these terms of service.

8. Governing Law

These terms and conditions are governed by and construed in accordance with the 
laws of Vermont and you irrevocably submit to the exclusive jurisdiction of the
 courts in that State or location.

Privacy Policy

Your privacy is important to us.

It is PedsOne's policy to respect your privacy regarding any information we may 
collect while operating our website. Accordingly, we have developed this privacy 
policy in order for you to understand how we collect, use, communicate, disclose 
and otherwise make use of personal information. We have outlined our privacy policy below.

- We will collect personal information by lawful and fair means and, where appropriate, 
with the knowledge or consent of the individual concerned.
- Before or at the time of collecting personal information, we will identify the 
purposes for which information is being collected.
- We will collect and use personal information solely for fulfilling those purposes 
specified by us and for other ancillary purposes, unless we obtain the consent of 
the individual concerned or as required by law.
- Personal data should be relevant to the purposes for which it is to be used, and, 
to the extent necessary for those purposes, should be accurate, complete, and up-to-date.
- We will protect personal information by using reasonable security safeguards 
against loss or theft, as well as unauthorized access, disclosure, copying, use 
or modification.
- We will make readily available to customers information about our policies and 
practices relating to the management of personal information.
- We will only retain personal information for as long as necessary for the 
fulfillment of those purposes.
- We are committed to conducting our business in accordance with these principles 
in order to ensure that the confidentiality of personal information is protected 
and maintained. PedsOne may change this privacy policy from time to time at PedsOne's 
sole discretion.