Medical Billing Companies & Consultants in Altoona, PA

PA Health Partners, LLC is a medical billing firm based in Altoona, Pennsylvania, that handles revenue cycle and administrative work for physician practices. The company positions itself as an outsourced alternative to an in-house billing department, and it works with doctor offices of every size, from solo practitioners to larger multi-provider groups. Billing is its core line of business, supported by provider credentialing and a hosting option for practices that run MEDENT electronic medical record software.

Billing on a contingency model

The firm's fee for billing is tied to results: rather than charging a flat rate, it takes a share of the money it actually brings in for each client. For a practice, that arrangement links the billing partner's income directly to collections, giving the firm a reason to pursue every payable claim. Its staff is described as trained in several different practice management and billing software platforms, so a client office does not necessarily need to change systems before handing over its claims. The company also stresses professionalism and confidentiality in how it treats patient and practice data.

Services offered

• Outsourced medical billing for physician offices
• Physician and provider credentialing with insurance carriers
• Preparation and submission of payer enrollment applications
• EMR server hosting for MEDENT users
• Complimentary audits of a practice's billing records and procedures
• Free initial consultations on outsourcing

On the credentialing side, PA Health Partners fills out the paperwork needed to get physicians enrolled and participating with whichever insurers an office requires. The team says it keeps current with the enrollment requirements of the major carriers operating in central Pennsylvania, which can be useful for practices adding new providers or expanding their payer mix. Its newer hosting service lets MEDENT clients place their EMR server on the company's own equipment for a monthly charge, which can lower the up-front hardware cost of adopting that system.

Why practices outsource to the firm

The company frames its value around removing the burdens of staffing a billing office. Clients avoid paying wages, benefits and payroll taxes for billing employees, and they no longer need to arrange coverage when staff are out sick, on vacation or on leave. PA Health Partners covers the cost of attending payer training seminars and shares updates on billing rule changes with clients at no added charge. Because the firm absorbs additional volume, a growing practice that brings on new physicians does not have to recruit extra billing personnel. Prospective clients can also request a no-cost review of their current billing practices, aimed at improving compliance and efficiency.

For buyers in Blair County and the surrounding region, PA Health Partners offers a locally based option with regional payer familiarity, a collections-based fee structure and specific expertise with the MEDENT platform. Its Facebook page notes a background of more than a decade working in the medical billing field, and the business is included in the Blair County chamber's online business directory under medical billing.

Physician Revenue Management Services, known as PRMS, is a medical billing and revenue cycle firm that works with physicians and medical practices. Listings put it in Altoona, Pennsylvania, and say it was founded in 2003. It is a full-service billing provider rather than a software vendor. After a practice sends patient and visit information, PRMS takes over the rest of the billing cycle. The firm puts its value in quality and accuracy rather than low pricing, and it warns practices that bargain billing services often cost them money through missed revenue.

How the engagement works

The client office supplies demographic details for each patient and the charges for each encounter. PRMS staff then handle charge entry, check that every encounter is captured, and prepare claims for the insurance carriers. Before submission, experienced team members review each claim so it goes out clean and is likely to be accepted by the payer. Coding support is also available for practices that want help with that step. Staff work in-house, so clients can reach people who know their account when billing questions come up.

Payment posting and reconciliation

PRMS spends a lot of attention on payment posting, which it treats as a key part of an efficient revenue cycle. Payments come in through several channels:

• Electronic remittance files, which post automatically to patient accounts and are then reviewed by staff for accuracy. For example, if secondary coverage is missing from a patient file, an ERA can wrongly shift the balance to the patient.
• Paper explanation-of-benefits notices, which the practice can send by electronic file transfer, fax or regular mail.
• Direct receipt of payments, where the practice routes checks to PRMS so office staff no longer open and sort mail. In this setup, payment-posting leads help the practice get a bank scanner so daily deposits can be scanned remotely.

Each of these routes has its own checks and balances, so posted amounts reconcile correctly.

Denials and appeals

The firm uses processes meant to keep denials low, but it recognizes that some rejected claims are unavoidable. Staff are trained to read denial reason codes and act on them right away. Recurring patterns go to management so the cause can be fixed for future claims. Claims that the firm believes were denied in error go through a structured appeal. PRMS first confirms the appeal is valid, then gathers supporting documents, files the appeal with the payer and reviews the result. If a claim is still unpaid, the team contacts the payer's provider relations staff.

What distinguishes PRMS

PRMS reports a mean collection rate of 97 percent for its clients. It argues that this lets practices keep more revenue than they would with cheaper services, even after the difference in fees. Listings also say it works with a range of practice management software, so practices may not need to change systems. Its stated view is that a practice still doing any billing work itself is not getting full revenue cycle management. For buyers comparing vendors, PRMS is an option for practices that want to hand off nearly all billing work and value in-house staff, careful reconciliation and steady denial follow-up.