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2009 Powerpoint Show2


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Mainstream Services Inc. presentation

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2009 Powerpoint Show2

  1. 1. Mainstream Services Inc.<br />You’ve taken care of your patients; <br />now let us take care of you…<br />
  2. 2. About Us<br />
  3. 3. About Us<br /><ul><li>Mainstream Services Incorporated is a premier electronic medical billing company.  With a direct focus on quality, accurate, expedient processing of medical claims we provide additional full management services to offer our clients a one stop solution to their claim processing needs.
  4. 4. Our team boasts more than 20 years of industry and corporate leadership experience.  Our medical billing and claims specialists are professionally educated and certified.
  5. 5. Our goal is to ensure our physicians and their staff can focus on the quality medical care they provide to their patients with the peace of mind that Mainstream Services Incorporated are focusing on their medical claim processing needs.  
  6. 6. What is most important to us in business is the reputation that will follow the Mainstream Services Incorporated name and brand. When Mainstream Services Incorporated is thought of, referred or spoken about in even general conversation it will be with the utmost admiration for a company committed to being the example of professionalism and outstanding service above all others. </li></li></ul><li>Mission Statement<br />           <br />At Mainstream Services Incorporated, we are committed to providing<br />exceptional services to our client base and those they service.  With this<br />direct focus in mind, we will exceed the expectations placed upon us by <br />expediently fulfilling the needs of our clients, their staffs, and their<br />patients.<br />
  7. 7. Our Policy<br />HIPAA Compliant <br />HIPAA compliance measures require stringent health care security and privacy practices that are intended to ensure patient confidentiality for all health care related information. Keeping these regulations in mind, MS Inc. is backed by technology and coding amenable to all HIPAA policies and is open to current and future HIPAA policies. <br />A brief look on how we empower you with HIPAA compliance: <br />Data Encryption - MS Inc. values client concerns for complete security and privacy. We utilize 128-bit encryption, which matches the highest industry standards and Secure Sockets Layer (SSL) technology for all data transmission. Norton, a renowned name in e-security certifications, powers our security certificate. <br />Physical Security - MS Inc. has built in strong physical security measures. These are a combination of special hardware and specific software measures to ensure security of the web site, servers and databases. Backed by firewall technology, all incoming traffic is intercepted to allow access to authorized users only. All critical systems are monitored 24/7 by experts trained in all aspects of physical and technical security. <br />User Authentication Security - Backed by proprietary software applications, MS Inc. controls access to restricted areas of the web site and database via login authentication. An automatic log off feature is in place to prevent unauthorized access to information in the event of the original user leaving the workstation without logging off. <br />Internal Audit - We record and regularly review all system activities, including but not limited to, login, file access and security events. MS Inc. uses this audit system to assess and critique its technical security measures. <br />Personnel Policies - Access to patient data is limited only to those employees who are liable to perform related tasks. Each employee is inherently made conscious to the fact that data accessed through their job functions is to be safeguarded and should not be disclosed to unauthorized parties. New employees are trained on all security systems and privacy policies during their initial orientation process. <br />Contingency Plan - MS Inc. has developed an emergency response plan, which is routinely updated and includes disaster recovery, data backup, as well as testing and revision procedures. This ensures our preparedness for any eventuality or contingency. <br />
  8. 8. Benefits of Outsourcing<br />There are great benefits to outsourcing your claims! You will eliminate extra staff, salaries, taxes, insurance, and <br />benefits. Lose the burden of administrative, office, and equipment cost. Cut the cost of collection by half or <br />more.<br />Reasons to outsource with MS Inc.<br />We will reduce your claim denial rate tremendously. <br />We will dispute all appeals. <br />We will supply you, your staff, and your patients with a skilled team to address your billing needs and/or concerns. <br />We will follow up on all claims submitted once every 5 days. <br />We are HIPAA compliant. <br />We will keep you informed of all changes in rules, laws, and payment schedules for your specialty. <br />We will keep you informed of the Medical/Dental code changes for you practice&apos;s encounter form. <br />Payment reimbursement will be released between 10-21 days.<br />Improper coding will cause:<br />Delay in your funds <br />High percentage in denied claims <br />Costly amounts being spent on resubmission of claims <br />The insurance carrier to down coding procedures, which means less money for you <br />Procedures to bundle and possibly not be paid at all <br />Customized monthly reports detailing our clients billing activity<br />
  9. 9. Benefits of Outsourcing<br />ADDITIONAL COSTS FOR <br />IN-HOUSE BILLING<br /><ul><li>Office Space
  10. 10. Office Equipment (Computer System, Phone, Fax, Scanner, Filing System)
  11. 11. Billing Software
  12. 12. Software Upgrades
  13. 13. Coding Books
  14. 14. Employee Training
  15. 15. Storage Space
  16. 16. Electricity
  17. 17. Phone Charges
  18. 18. Office Supplies (HCFA Forms, Statement Forms, Envelopes)
  19. 19. Clearinghouse Charges (ex. electronic remittance advise)
  20. 20. IT Server Maintenance
  21. 21. Postage
  22. 22. Employee Payroll Tax </li></ul>THIS COULD ADD UP TO THOUSANDS!!<br />*Note:  In-House costs based on industry averages, actual amounts can vary based on practice and size. Contact a us for a custom Cost Analysis Worksheet. <br />
  23. 23. IN THE NEWS<br />Excerpt from Health Care&apos;s Six Money-Wasting Problems<br />by Parija B. Kavilanz<br />Monday, August 10, 2009<br />provided by CNNMONEY.COM<br />More than $1.2 trillion spent on health care each year is a waste of money. Members of the medical<br />community identify the leading causes.<br />Down the drain: $1.2 trillion. That&apos;s half of the $2.2 trillion the United States spends on health care each year,<br />according to the most recent data from accounting firm PricewaterhouseCoopers&apos; Health Research Institute.<br />What counts as waste? The report identified 6 different areas in which health care dollars are squandered.<br />But in talking to doctors, nurses, hospital groups and patient advocacy groups, six areas totaling nearly $500 <br />million stood out as issues to be dealt with in the health care reform debate.<br />Those Annoying Claim Forms<br />Inefficient claims processing is the second-biggest area of wasteful expenditure, costing as much as<br />$210 billion annually, the PricewaterhouseCoopers report said.<br />&quot;We spend a lot of time and money trying to get paid by insurers,&quot; said Dr. Terry McGenney, a Kansas City, Mo.-based family physician.<br />&quot;Every insurance company has its own forms,&quot; McGenney said. &quot;Some practices spend 40% of their revenue filling out paperwork that has nothing to do with patient care. So much of this could be automated.&quot;<br />Dr. Jason Dees, a family doctor in a private practice based in New Albany, Miss., said his office often resubmits claims that have been &quot;magically denied.“ &quot;That adds to our administrative fees, extends the payment cycle and hurts our cash flow,&quot; he said. Dees also spends a lot of time getting &quot;pre-certification&quot; from insurers to approve higher-priced procedures such as MRIs. &quot;We&apos;re already operating on paper-thin margins and this takes times away from our patients,&quot; he said.<br />Susan Pisano, spokeswoman for America&apos;s Health Insurance Plans, said &quot;hundreds of billions&quot; of dollars can be saved by standardizing procedures and using technology -- something the White House has mentioned as a key to health care reform. &quot;For that to happen, we need the technology,&quot; she said. &quot;Doctors and hospitals must adopt the technology, and we have to develop rules for exchanging of information between doctors, hospitals and health plans.“ Pisano said the industry is launching a pilot program later this year that will allow physicians to communicate with all health plans using a standardized process.<br />
  24. 24. Services<br />Claims Processing<br />Full accounts management<br />Creation and submission of electronic and paper claims<br />Payment posting of EOB/patient payments<br />Creation and submission of appeals for denied claims <br />Review and follow-up on aged claims <br />Claim tracking analysis <br />Review of all coding on claims and data<br />Generation of monthly statements <br />Collections<br />Preparation of collections and documentation when necessary <br />Soft collections <br />Work with third party collection agency/attorney&apos;s when necessary<br />Additional Services:<br />Patient Well Care Services<br />Options for how your claims will reach us <br />Notary Services<br />
  25. 25. Billing Services<br />
  26. 26. BillingServices<br />Traditional Billing Services <br />• Electronic & Paper Claims Processing • Patient Statement Processing and Mailing (Electronic & Manual) • Insurance Follow-Up and Soft Collection Services • Post Patient and Insurance Payments• Provide Secondary and Tertiary Insurance Billing <br />Advanced Billing Services<br />With advanced technology, we will be able to exchange information remotely between my medical billing service and the <br />physician computers. This software allows me to expand my services outside of my immediate service area and into other<br /> states making distance barriers obsolete. <br />Full Service Billing<br />Our services include electronic and paper claims filing. We process claims electronically to all carriers that currently accept <br />electronic submission. Payers that do not accept electronic submission will be sent via paper. We will then follow-up with<br /> insurance carriers and/or our clearinghouse to assure claims have been accepted. We will forward secondary claims upon <br />receipt of primary&apos;s EOB. We will post all payments and track all claims that have gone unpaid beyond 30 days. If an unpaid <br />or underpaid claim requires an appeal, we will resubmit the claim with the required information and handle all necessary <br />follow-up. <br />Our full service billing also includes generation of patient statements on a daily basis. We provide a &quot;soft &quot;collection<br /> method for patients consisting of letters and telephone calls if necessary. We recommend you have a &quot;merchant account“ <br />offering your patients an alternative way to pay.   <br />When the need arise, we also work with third party collection resources on your behalf. <br />
  27. 27. Collections<br />As a successful billing service, we will work to effectively resolve 100% of insurance claims at a minimal cost to our doctor<br />clients dealing with both insurance companies and patients. <br />While most claims get paid within a few weeks, a small percentage of claims does not get resolved and can be difficult to <br />conclude. You typically file tracers and even make phone calls to the insurance companies but, unfortunately receive <br />marginal if any response. This small percentage of claims may remain uncollected for months. <br />Since you are not setup as collection agency to deal with these unpaid accounts, many doctors are often faced with two <br />difficult choices. Either write off the unpaid accounts or refer them to a hard-core collection agency. In which case the <br />medical practice loses 30 to 50% of the value of the claim. In addition to this high percentage fee, the practice will most <br />likely lose the patient as a client. Harsh collection measures usually result in the loss of patient goodwill. <br />What we wish to provide you is an ability to close the book on every insurance claim by utilizing this service only on those <br />specific and few claims requiring this type of additional effort. We will provide this at a fee which frankly is not possible for <br />your company or your staff to approach, not even considering the impact and effectiveness of our national collection <br />program. <br />RECOVER MONEY FASTER: Unlike other collection agencies, past-due accounts are instructed to pay the doctor directly. We collect from both patients and insurance companies. <br />SAVE ON INTERNAL & COLLECTION COSTS: Reduce internal costs by as much as 30% and your collection costs by as much as 50% by using our collection system. <br />RETAIN CONTROL, PATIENT LOYALTY & GOODWILL: You decide when to start collection activity, when to stop, and how they want each account handled; diplomatically or intensively. <br />INSURANCE CLAIM COLLECTION SYSTEM: Significantly reduces the days outstanding for insurance and workers compensation claims and reduces the number of days needed to follow up on claims. <br />
  28. 28. Well Care Services<br />
  29. 29. Well Care Services<br />As a well-care service provider, we manage your outreach program to help maintain communication with your patients. <br />Our service will provide a great public relations service to you. It consisting of letters and postcards to remind patients of <br />their need for various services, such as check-ups, testing, immunizations, etc. We maintain a positive relationship with <br />your clients that goes beyond just treating in your office. <br />The program provides the following benefits: <br />Routine correspondence such as recall cards (appointment reminders) and thank you cards to colleagues and patients are<br />an integral part of maintaining patient base and loyalty. We can either use your cards or customize one to fit your patients <br />needs.<br />Patients will receive timely notice of when they are due for an appointment. We can also create patient birthday cards to <br />strengthen your relationship with them, promote referrals, and promote repeat business. Mainstream Services Inc. is <br />proud to offer this valuable service. <br />Promotes and Maintains Patient Relationships <br />Keeps Office Staff Focused on Helping Care For Patients <br />Builds the Medical Practice and Increases Profits <br />Compliments Any Existing Customer Care Programs <br />Pays For Itself As Patients Respond To The Program <br />Gives The Doctor More Time To Be A Doctor <br />
  30. 30. Frequently Asked Questions<br />You have questions<br />We have answers<br />
  31. 31. F.A.Q’s<br />Q: How will we get our claims to you for processing?<br />There are several ways for your office to send in your billing, including the following... <br />Fax - the quickest way to get your billing to us! Just fax each completed document to our office on an as needed basis (after each visit, at the end of each day, once per week, etc). <br />Email -<br />Overnight via any major courier<br />Q: How often should we send our new billing to you? <br />As often as you choose to! We personally recommend, however, that our clients send us their new billing consistently on <br />either a daily or weekly basis. <br /> <br />Q: What information is needed in order for your office to generate a claim on our behalf? <br />We require the following... <br />New Patient Information Form <br />A copy of the patient&apos;s insurance card or WC ID card (front and back <br />A copy of the patient&apos;s written prescription (if applicable) <br />The patient&apos;s first Superbill (treatment form) <br /> <br /> <br /> <br />
  32. 32. F.A.Q’s continued<br />Q: How do we report when treatments are rendered, so that you are able to generate a claim on our behalf? <br />We must receive a completed Superbill (treatment form), which has been signed by the physician rendering the services. This form must contain: <br />Patients name <br />Name of insurance carrier <br />CPT codes <br />ICD-9 code(s) <br />Referring physician&apos;s name and the referral # <br />Any/all applicable modifiers <br /> <br />Q: Do we have to report the insurance payments received in our office to you? <br />Yes! It is vital to your practice that we receive this information, so that we can enter the insurance carrier&apos;s payments and generate the necessary patient statements for those accounts which still may have a balance due.<br />Q: What happens if we accidentally omitted any of the information contained on the required forms, and we already sent them to your office? <br />You will receive a report indicating that the claim does not contain enough information to be processed by the carrier, listing exactly what is missing, which is normally faxed to your office immediately. We do this as a courtesy to you and your staff, to assist in gathering the information quickly, and to avoid timely filing deadlines that are imposed by many insurance carriers. <br />
  33. 33. F.A.Q’scontinued<br />Q: How do we report payments received from our patients, for both co-payments and patient billing? <br />You can easily report a patient&apos;s co-payment, made at the time of service, on their Superbill (treatment form) for that day&apos;s <br />treatments. You can also report all of the patient&apos;s payments, received in the mail, by keeping a Payment Log. A payment <br />log enables you to report all payments received in your office, using one simple form. If you do not already use this type of <br />form in your practice, we can custom design one for you. You can also report all of the patient&apos;s payments, received in the <br />mail by making a copy of the check and attaching it to their patient statement remittance (if returned). <br /> <br />Q: How often will our patients be billed? <br />Any patient in our system will receive a bill for any balance due, once a payment has been received by their insurance <br />carrier, if you have contracted for this service. Patients are billed bi-monthly. Payment plans can also be easily<br /> accommodated.  <br />Q: How do you handle non-payments from an insurance carrier? (Denials, etc.) <br />We must first determine if the denial, whether in part or in full, is valid. If the denial is valid it must be written off. If the <br />denial is not valid, as in many of the cases, we will request that the carrier reprocess the claim. Unfortunately, many carriers <br />will require that the claim be resubmitted on paper via snail mail, and additional charges may be invoiced to your account <br />as a result. <br /> <br />Q: How do you handle non-payments from a patient? <br />We will send out no more than four statements, and make follow up phone calls. After 120 days we recommend that the <br />account be turned over to collection. If you are not already affiliated with a collection agency near you, please let us know <br />as we are and can handle this for you. <br />
  34. 34. Contact Us<br />Office Hours <br />Monday - Friday   <br />8 AM - 4:30 PM CST<br />Visit our website @ and submit our electronic survey!<br />   <br />  <br />Email<br />Phone  (800) 580-9721<br />Fax:       (800) 580-9721 (intelligent fax, same as phone number)<br />            <br />Mail:  <br />Mainstream Services Inc.<br />ATTN: Enrollment<br />432 East 162nd Street, Ste. 134<br />South Holland, IL 60473<br />
  35. 35. Mainstream Services Inc.<br />You’ve taken care of your patients; now let us take care of you…<br />Thank you for watching our presentation.<br />Please don’t hesitate to contact us today!<br />