Medical Billing in Philadelphia

Penn Medicine, Jefferson, Temple, Children's Hospital of Philadelphia and Main Line Health sit within a few miles of each other, which makes Philadelphia one of the most concentrated academic medicine markets in the country. For an independent practice, that means competing with, and often depending on, a handful of very large names.

Who pays here

Independence Blue Cross is a major commercial plan in Southeast Pennsylvania, and any billing company working this region should be at ease with its edits and appeals. Medicaid here is delivered through HealthChoices, a managed care program, with several plans for members to pick from. Medicare Advantage is large too, especially in the older neighborhoods of the Northeast and in the suburbs.

Two things set Philadelphia apart. Many residents are on Medicaid, so any practice treating the neighborhood has plenty of it in the mix. And the suburban counties around the city are more commercial and more affluent. A group with a city office and a Montgomery County office has two payer mixes to run.

Philadelphia also has a strong tradition of unions and large nonprofit employers, and their plans are often self-funded and administered by a carrier. That can make claim rules differ between two patients with the same insurance card.

South Jersey is part of the same patient market. If you are near the bridges, a good number of your patients come from Camden County and beyond, and some New Jersey plans may sit outside the Pennsylvania networks you already know. Add one question to your intake: where does the patient live, and where does the plan sit?

Pennsylvania and New Jersey in one practice

Camden is across the Delaware River, and patients cross the bridge both ways. If your practice sees New Jersey residents, you need credentialing with New Jersey plans too. Cooper University Health Care anchors that side of the river. Different states usually mean different timely filing windows and different Medicaid portals. A company that has only billed Pennsylvania can learn New Jersey, but you will pay for the learning curve unless you ask about it up front.

Norristown and Chester sit on different edges of the region and have very different patient bases: a county seat with a growing suburban population, and a river town with a long history of economic trouble. A single billing contract has to handle both without treating either like the other.

Residency programs and what they leave behind

Philadelphia trains a lot of physicians, and plenty of them stay. That means a steady supply of newly practicing doctors starting groups, buying into practices or joining small ones. New physicians arrive with no payer enrollments, and the first few months are the most expensive in billing terms: visits happen, claims wait. A company that does credentialing well can shorten that gap, so ask how many days it usually takes and who handles the paperwork.

Older row-house neighborhoods also mean a lot of small storefront practices in primary care, podiatry, physical therapy and counseling. These tend to be one-owner offices that have never had a billing department, and a company needs to be comfortable starting from scratch. If the intake process is a form and a login, expect trouble. If it is a call about how your front desk works today, expect better.

Temple and Jefferson graduate large classes of doctors, many of whom stay in the city and open practices in places like Northeast Philadelphia and South Philadelphia. Those new practices tend to be in older commercial buildings where internet service is unreliable, so ask how the company handles a practice that is only sometimes online.

Reading a proposal

A proposal should name the software the company will work in. It should spell out who owns your data and in what format you get it back, and what happens to claims in process if you leave. It should describe how denials are worked and by whom. It should say where your account staff are based and what privacy training they carry. Finally, look for reports on how often claims pass on the first try and how old your open balances are, written so you can read them without a decoder.

Ask for references from practices of your size and specialty, not a long list of hospital departments. In Philadelphia, a firm whose clients are all big systems will bring the wrong habits to a four-person office.

Pay attention to what is not in the proposal. If the company does not say who works the claim after it is denied, the answer is probably nobody. If it does not say how it handles patient calls, the answer is probably you. Fill those blanks before you sign.

Winter and the slow months

Philadelphia practices see a predictable dip in January and February, when snow and flu season rearrange the schedule. Cash flow follows. Ask if the company reports trends month by month so you can plan around that, or only hands you a total.

Row-house neighborhoods in South Philadelphia, Kensington and the Northeast also mean limited parking and tight offices, so many practices rely on a single front desk person. If that person is out sick, claims stall. Ask if the billing company can cover entry and eligibility when your own staff cannot.

Medical Billing Cost Costs in Philadelphia

The cost of a medical billing company in Philadelphia is most affected by the volume of bills a practice needs to process and collect.

Below are estimated costs for medical billing company costs in Philadelphia:

Note: Prices subject to change. These costs are based on an average of Alluvit's Philadelphia medical billing company research.

Medical Billing Companies in Philadelphia, PA

• St Mary's Regional Medical Ctr

  
  
  

  PO Box 95000
  Philadelphia, 19195-0001

  (207) 777-8100

• Excellerx Inc

  
  
  

  1601 Cherry St # 1800
  Philadelphia, 19102-1314

  (215) 282-1600

• Medical Advantage Inc

  
  
  

  1546 Packer Ave
  Philadelphia, 19145-5448

  (215) 334-4342

• QTC Medical Svc

  
  
  

  1617 J F K Blvd # 300
  Philadelphia, 19103-1800

  (215) 568-1640

Looking for a different city? Here are some nearby.

Other Philadelphia business topics.

• Benefits Of Outsourcing Medical Billing