Frequently Asked Questions


We use a state-of-the-art billing software and security system, eliminating the cost and worry associated with running these systems in your practice. Using our service will reduce your overhead and the problems associated with the turnover, salaries, and management and hiring of qualified personnel. Your collection processes won’t suffer from employee-related illness or vacation. Another important benefit to consider is that no one in your practice will be aware of the amount of revenue you generate, and your privacy will not be compromised. The greatest benefit you will enjoy is a worry-free wonderful time with your family, your favorite sports and hobbies, knowing that Pier 17 professionals expertly handle the financial side of your practice.

Pier 17 has been proudly providing services to the New York Tri-State area medical care providers since 1991.

We are prepared to provide expert billing services for any medical specialty. Currently, we are proud to be serving providers specializing in: cardiology, chiropractic medicine, colon & rectal surgery, dermatology, family practice, gastroenterology, general and vascular surgery, internal medicine, neurology, OB/GYN, ophthalmology, pain management, pediatrics, physical medicine and rehab, physical therapy, plastic surgery, podiatry, psychiatry, radiology and urology. Our services extend beyond professional billing to institutional billing of adult daycare centers and drug and alcohol rehabilitation facilities.

We will definitely work with your old unpaid claims and make sure that you get paid in accordance with carrier rules and regulations.

Follow-up is a standard process we use to resolve insurance denials of claims. Our claims follow-up department ensures that every line of service on every claim is reimbursed. Follow-up specialists are trained to investigate carriers’ reports and determine why the service(s) is not paid, as well as which steps are necessary in order to receive payment. We appeal unreasonably denied claims within the time limit and according to regulations set by each individual carrier. In addition, we file second level appeals and complaints with government agencies where necessary. We know that every penny counts and with Pier 17, no small-dollar, secondary claims are left in the dust.

Electronic Medical Record (EMR) or Electronic Health Records (EHR) systems are an efficient way to manage medical practice operations and records (i.e. practice schedules, inter-office communications, patients’ medical records, electronic prescribing) in a fast and secure way. 

All major EHR software providers may be integrated to function with outsourced medical billing, including Allscripts, Cerner, eClinicalWorks (ECW), eMDs, EPIC, Kareo, MDLand, MedGen, MedENT, NextGen, Practice Fusion, and Practice Suite.

For all practices working with Pier 17, our Provider Support Department works hand-in-hand to customize and integrate medical billing templates, superbills, insurance claim processing, and any other functions associated with the medical billing process.  Most importantly, we provide ongoing, one-on-one, training for the physicians and staff in your practice. 

For more information about Pier 17’s outsourced medical billing integration for EHR / EMR, please contact us.

Although the terms telehealth and telemedicine are often used interchangeably, there are distinct differences between the two.

Telehealth includes a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole. Telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

Telemedicine refers to the actual medical services being provided via Telehealth. It involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Telemedicine technology is frequently used for follow-up visits, management of chronic conditions, medication management, specialist consultation, and a host of other clinical services that can be provided remotely via secure video and audio connections.

For providers seeking to incorporate telemedicine into their practices, our Provider Support Department can help coordinate the implementation of virtual encounters and telemedicine billing. For more information, please contact us.

Coordination of Benefits, also known as COB, is used by insurance providers to differentiate which services are covered by the primary, secondary, or in some cases a tertiary insurance. If a patient does not update their COB in a timely manner, insurance companies can reject authorization requests and deny claims, citing no “primary” insurance on file with the patient’s carrier. For this reason, it is crucial that patients with more than one insurance carrier continuously update their COBs with all of their carriers.   

If there is a question over COB with an insurance carrier, the patient is the only party who may resolve it.  Insurance carriers will not accept COB directly from a medical provider.

For more information about coordination of COB, please contact our Provider Support Department.

Many insurance providers use third-party vendors such as AIM, Cohere Health, Evicore, Orthonet, RadMD, and Turning Point, for prior authorization processing. These third-party vendors are responsible for reviewing precertification requests and providing prior authorizations on behalf of the insurance providers. 

The process of obtaining a prior authorization through a third-party vendor is the same as obtaining an authorization directly from the health plan, including a medical necessity review by staff nurses and/or physicians, and, where applicable peer-to-peer reviews. 

The standard process of submitting a prior authorization request includes sending a precertification form with the required patient medical records, establishing medical necessity, following up on the request, and obtaining an approval. 

For more information about obtaining prior authorization from Third-Party Vendors, please contact us.

Unfortunately, when medical claims get denied for no prior authorization, they cannot be appealed. In some limited circumstances, retroactive authorizations may be requested if a prior authorization was not obtained in advance of the medical service.  In either case, if an authorization is required (whether prior or retroactive), simply appealing a denial will not result in payment of your claim.

For more information about avoiding claim denials based on failure to obtain prior authorizations or retroactive authorizations, please contact the Pier 17 Authorizations Department.

Health insurance carriers are “imperfect creatures”, especially when it comes to paying claims.  It is also common knowledge that private practice medical providers often lack the time and staffing for proper revenue cycle management (i.e. medical providers miss or simply don’t follow up on wrongfully denied claims).  The result is wrongfully denied medical claims for properly billed medical services.  

However, in some circumstances, “No Prior Authorization” denials may be valid (even when you think they’re not).  For example, if a prior authorization was issued for only one unit of a specific CPT code, but the claim was submitted for two units of that CPT code, the claim will be partially denied. 

For more information about responding to claims that are wrongfully denied for “No Prior Authorization” and Revenue Cycle Management, please contact us.

Medical necessity refers to the requirement that healthcare services provided to a patient are appropriate and necessary to diagnose or treat a medical condition. Medical necessity is determined by several factors, including the patient’s medical history, symptoms, and the standard of care for their condition. Healthcare services that are not medically necessary may not be covered by insurance providers, leading to out-of-pocket costs for the patient.

If your medical records are deemed invalid, it could mean that the services provided were not medically necessary. This could be due to several factors, such as a lack of documentation or insufficient evidence to support the medical necessity of the services provided. In some cases, medical necessity may be denied due to a lack of coverage or an exclusion in the insurance policy.

To avoid invalid records, healthcare providers should ensure that their documentation accurately reflects the medical necessity of the services provided. This includes documenting the patient’s medical history, symptoms, and the rationale for the services provided. Healthcare providers should also stay up-to-date on the latest evidence-based guidelines and protocols for their specialty to ensure that their services are appropriate and necessary.

Overall, understanding medical necessity is essential for healthcare providers and patients alike. By ensuring that healthcare services are appropriate and necessary, patients can receive high-quality care and avoid unnecessary costs.

If your practice is experiencing denials or rejections after medical necessity reviews, Pier 17 can help. Please contact us for more information.

Medical claim processing is regulated by federal and state laws.  In most cases, insurance carriers and health maintenance organizations are required to process clean claims within 30-60 days.

Under New York State Insurance Law, for example, insurers and health maintenance organizations (HMOs) are required to pay undisputed claims within 45 days after the insurer receives the claim, or within 30 days if the claim is transmitted electronically.

No matter the state that your medical practice is located in, the best method for ensuring prompt claim processing and quick payment is to submit clean claims: meaning, correct and complete patient demographics, insurance coverage, ICD-10 Codes, CPT codes, and prior authorization(s) (where required).  

If your practice is struggling with delays in claims processing, billing clean claims, or Revenue Cycle Management, we can help.  Please contact us for more information.

Yes, patients are invoiced on a monthly basis for any money owed to the medical practice. In most cases, patient balances are the result of: co-payments, co-insurance, deductible, insurance terminations, or other uninsured events. Prior to sending out invoices, Pier 17 prepares a monthly list of patient balances owed to the medical practice’s for review. Once approved, patients are invoiced electronically or by regular mail.  

For more information about patient invoicing or the overall medical billing process with Pier 17, please contact us

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