address the needs of the practice that most impact development, progression, and the bottom line. We provide solutions in areas of the practice where there are obvious opportunities for improvement.
We review your fees in conjunction with other fees in your geographic area, in addition to our reimbursement experience from major payers. We identify fees that are lower than found in your geographic area, as well as any fees that are below a percentage of Medicare rates. We will then develop a report that identifies current utilization per CPT code and recommend the appropriate fee amount.
Our analysis will provide you with a "in depth" overview of outstanding balances and develop the management systems needed to decrease your A/R. The first priority is the unpaid or delayed claims that inflate the A/R to unmanageable proportions. Managing your A/R requires a review of the A/R and identify areas where there are potential demographic inconsistencies and how to improve the process. We provide the daily, weekly and/or monthly training necessary to educate your staff on proper reimbursement methodologies. We concentrate on your aged accounts and provide a short and long-term plan for development and improvement.
Having an employee handbook and defined job descriptions with competitive salary ranges allows for a more structured work environment. Employees are better managed and are more productive when they understand their role within the practice. As a by-product, employee retention increases and the cost of hiring and the placement of advertisements decrease. An input/output model will reviewed to illustrate the relational job functions for employee's to better understand the workflow and operational processes that directly affect one another. With Human Resource Development; a customized employee handbook will be developed and approved by the partners/owners of the practice. Job specific employee job descriptions will be developed to meet the needs of the practice. Wage scales will be reviewed and approved by the partners/owners. Performance evaluations will be compiled to demonstrate the employee's job performance, areas of training and development, and salary increases, if any.
Understanding where you stand in the reimbursement market is the key to managing your practice's receivables. We have discovered most of our clients do not know what the reimbursement rates are for their charges. Payors are reluctant to tell and practices don't know to ask. We determine your current reimbursement contracted amounts, then compare through a reimbursement payor matrix to where the practice is in comparison to the market. Are the rates of fair market value? What is the percentage of reimbursement compared to the current years Medicare rate? For those plans that fall below fair market value, we initiate discussions with those identified payers and attempt to acquire a rate that best represents a fair market price. The practice will then be provided with an up to date and current payer reimbursement matrix with the newly negotiated rate.
We identify the practices highly protected CPT codes by utilization to insure that the negotiation process is inclusive of the CPT codes that best represent the practices highest charge out amounts. In addition, we will develop a payer utilization report to identify payer production within the practice. This will allow us to determine which plan(s) require termination due to a combination of low penetration and reimbursement, and which payers require direct marketing to increase patient penetration because of higher reimbursement.
An evaluation of the revenue cycle process is evaluated to determine strengths and areas of opportunity. We conduct an audit trail to review provider charges, documentation practices, workflow, actual billing application, billing software systems, reporting capability, claims submission, accepted and rejected claims analysis, electronic data interchanges, insurance and patient A/R maintenance, and the evaluation of internal controls. We follow an audit trail designed specifically to capture other areas of revenue potential within the practice.
This assessment encompasses an evaluation of the operational, functional, and financial environment. We initiate employee interviews, administrative and clinical. Discuss practice related participation, quality of life issues and accountability with physicians. We address all aspects of patient care and evaluate the processes from patient arrival to patient check out. We evaluate the revenue cycle process and make recommendations for implementation and areas of opportunity.
At completion of the comprehensive assessment, the partners/owners of the practice receive a complete guide to our findings and recommendations for each area. This assessment does not cover the implementation process. See on-site engagement options for Practice Assessment implementations.
This engagement provides hands on development services that mentor and coach individual employee's in various departments on how to properly manage their workflow. Process management allows employee's to understand organizational dynamics and integration of departmental job functions. Basic Practice Development include:
- Fee Schedule Analysis and Development
- Operational workflow analysis and development
- Audit procedures for collection of statistical data
- A/R auditing for payor and patient receivables
- Audits to ensure complete charge capture
- Monthly statistical reporting
In addition to the services offered in Basic Practice Development, Comprehensive Practice Development adds:
- Business Office Operations Analysis
- Evaluate & Negotiate Third Party Contracts and Reimbursement Rates
- Human Resource Services (employee handbook, job descriptions, policies and procedures, performance reviews, coaching and development).
We have experience and knowledge in contractor bidding and selection process; assist in the design and ergonomic flow of patients and the necessary space requirements for potential practice growth. In addition, we work with local financial institutions to develop strategic partnerships to provide suitable medical care to the community while acquiring fair and affordable construction costs. Our network of business relationships allows us to manage the project from beginning to end.
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