Mdeverywhere\'s solution for Hospitalists


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Mdeverywhere\'s solution for Hospitalists

  1. 1. Physician-Centric Revenue Cycle Management Company Cathy Steadman Director of Business Development
  2. 2. About MDeverywhere <ul><li>MDeverywhere’s mission is simple – to increase your practice revenue </li></ul><ul><ul><li>Our product is a paid claim </li></ul></ul><ul><li>Founded 1995, 500+ Employees </li></ul><ul><li>Currently Serving: </li></ul><ul><ul><li>3,200 physicians nationwide </li></ul></ul><ul><ul><li>Over 60 different specialties </li></ul></ul><ul><ul><li>Group practices, faculty practices, hospital departments </li></ul></ul>
  3. 3. Interfaces and Workflow Register Patients HOSPITAL SYSTEM Web / Handheld Charge Capture MDEVERYWHERE Charge Capture ADT Interface Demographics Submit Claims Post Payments Appeal Denials Work AR MDEVERYWHERE Back-Office
  4. 4. The MDeverywhere Difference Eliminate Lost Encounters & Reduce Days to Billing Decrease Denials by 90% Enforce Payer Contracts Earn PQRI Bonus Visibility & Control We will increase revenue 5% to 15%
  5. 5. How We Increase Revenue: 1. Rules Engine Reduces Denials 90% <ul><li>Handheld & web-based charge capture delivering rules at point-of-care </li></ul><ul><ul><li>15 Million pre-defined Payor Specific rules including: </li></ul></ul><ul><ul><li>Additional rules built based on your denials = System Gets Smarter </li></ul></ul><ul><li>Incorrect Diagnosis Code </li></ul><ul><li>Bundling/Unbundling </li></ul><ul><li>Missing Modifiers </li></ul><ul><li>PQRI Measures </li></ul><ul><li>Invalid Referring Physician </li></ul><ul><li>Global Period Edits </li></ul>
  6. 6. How We Increase Revenue: 2. PQRI & E-Prescribing Rules = 4.0% Bonus <ul><li>Physician Quality Reporting Initiative (PQRI) </li></ul><ul><ul><li>Rules engine supports the current PQRI quality measures </li></ul></ul><ul><ul><li>If a patient is eligible our rules engine automatically enters PQRI procedure codes </li></ul></ul><ul><ul><li>Result: 2.0% Medicare bonus </li></ul></ul><ul><li>E-Prescribing rules will earn you the 2.0% Medicare bonus </li></ul>
  7. 7. How We Increase Revenue: 3. Eliminate Lost Charges & Reduce Days to Billing Actual Client Outcomes Reduced Days to Billing
  8. 8. How We Increase Revenue: 4. Payor Contract Compliance <ul><li>Commercial payors underpay claims by 7% </li></ul><ul><ul><li>We build a knowledge base with your payor contracts and payment rules (multiple surgery reduction, etc.) </li></ul></ul><ul><ul><ul><li>We know what you are supposed to be paid on every claim </li></ul></ul></ul><ul><ul><li>Appeal every claim where the payment is less than the contracted amount </li></ul></ul>
  9. 9. Payor Contract Compliance Identify Underpayments
  10. 10. Payor Contract Compliance Appeal All Underpayments
  11. 11. How We Increase Revenue: 5. Referring Physician Communication <ul><li>Fax sent automatically to referring physician when a patient is admitted to and discharged from the hospital </li></ul><ul><ul><li>Customized fax includes patient name, diagnosis, procedures, admission (discharge) date and attending physician </li></ul></ul>
  12. 12. <ul><li>Our Web Based Practice Management Software offers Improved Visibility, Transparency and a Streamlined Workflow </li></ul><ul><ul><li>Patient Ledgers </li></ul></ul><ul><ul><li>Batch Status </li></ul></ul><ul><ul><li>Patient Accounts Receivable </li></ul></ul><ul><ul><li>Management Reports </li></ul></ul>Administrative Benefits: Visibility
  13. 13. Administrative Benefits: Patient Ledger
  14. 14. Administrative Benefits: Workflow Tracking
  15. 15. Administrative Benefits: Patient Accounts Receivable
  16. 16. Administrative Benefits: Management Reports <ul><li>Insurance Aging Summary </li></ul><ul><li>Insurance Aging Detail </li></ul><ul><li>Patient Aging Summary </li></ul><ul><li>Patient Aging Detail </li></ul><ul><li>Charge, Payment & Adjustment Summary </li></ul><ul><li>Procedure Analysis </li></ul><ul><li>Denial Summary </li></ul><ul><li>Denial Detail </li></ul><ul><li>Net Collection </li></ul><ul><li>Executive Summary </li></ul><ul><li>Payor Mix </li></ul><ul><li>Web based reports by doctor and department are available to different users based on their access level </li></ul><ul><li>MDeverywhere can also create custom reports for your practice </li></ul>
  17. 17. Net Collection Report: Our Report Card Charges by date of service Payments tie back to date of service Money we are not allowed to collect Professional discount Bad Debt Net Collections % = (Payments) / (Charges – Contractual Write-offs – Discretionary Write-offs)
  18. 18. Denial Summary Report
  19. 19. Our Start Up Process <ul><li>No software license fees </li></ul><ul><li>No maintenance or support fees </li></ul><ul><li>No interface, training or conversion fees </li></ul><ul><li>Deposit equal to one month of service is refunded to client after start-up </li></ul><ul><li>We get paid a percent of collection </li></ul><ul><li>Implementation Time: 8 - 12 weeks </li></ul>