Get More Money Faster into your Medical Practice

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View why more and more medical providers are outsourcing their Billing with new state-of-the-art service

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Get More Money Faster into your Medical Practice

  1. 1. Get More Money Faster
  2. 2. Introduction Med-Billing Solutions, LLC Stephen St. Gelais, Owner/ Consultant Part of a nationwide network of over 1500 independently operated offices; established in 1994 We specialize in assisting medical providers nationwide with enhancing their cash-flow, profitability and office productivity. We accomplish this through a variety of our proprietary state-of-the-art billing solutions services. Our Core Service Focus #1 Responsibility: Insure we're capturing the workload documentation you have performed with your patients #1 Goal: Assure that you're receiving the maximum revenue you're entitled by optimizing your "RVU" (Relative Value Unit). #1 Priority: "Denial Management“
  3. 3. Introduction Medical Billing & Coding Financial Services Stephen St. Gelais Edward Albrecht Certified Public Acct. Marketing & Advertising Kristine Vail Bob Charney Banking & Finance Information Technology Alice Madrid-Neumann Terry Schladetzky Business Brokerage Real Estate Robert Fiance Linda Brown Legal Joining us soon… Mark Pearl Medical Waste, Construction, and more… Flagship Charity: Dedicated to serving the "OwieBowWowie and Friends Foundation” medical community Gina Gippner-Woods
  4. 4. Agenda Cash-Flow Pipeline Push your A/R into the “current” column Increase per claim profits When the patient can’t pay in full Eliminate write-offs/ Recover lost profits The “RAC” – will your practice be ready? Considering EMR?
  5. 5. The Cash Flow Pipeline Getting & Reducing Delivering Collecting Keeping Expenses, Services Money Patients Losses 5
  6. 6. Pushing your A/R Insurance Aging Insurance Aging Report Rendering Provider: Dr Aaaaaaaa A Aaaaaaaa Location: All Locations Billing Provider: Dr Aaaaaaaa A Aaaaaaaa Based on Submission Date Insurance Current 31-60 61-90 91-120 Over 120 Balance Tricare Prime 0.00 0.00 0.00 0.00 375.00 375.00 Horizon Bcbs Of New 0.00 0.00 0.00 0.00 125.00 125.00 Jersey Bcbs Of North Carolina 0.00 0.00 0.00 0.00 50.00 50.00 Aetna Hmo 0.00 0.00 280.00 0.00 0.00 280.00 Aetna 0.00 0.00 0.00 0.00 180.00 180.00 Report Totals: $0.00 $0.00 $280.00 $0.00 $730.00 $1010.00 Percent Total Aged: 0.00% 0.00% 27.72% 0.00% 72.28%
  7. 7. New Patient INSURANCE LEDGER CARD Bookkeeper BILLER CHART Information _________ _________ ID CARD SUPERBILL DOCTOR CLAIM SIGNED RECEPTIONIST AUTH. LOCAL POSTAL POST OFFICE POST OFFICE CARRIER INSURANCE Mail Room COMPANY CLERK CLAIMS PROCESSOR CLAIMS AND ATTACHMENTS DATA ENTRY CLERK Life of a typical ACCEPTED CLAIMS Medical Claim REJECTED 30 to 120 Days CLAIMS DOCTOR’S OFFICE POSTAL LOCAL Mail Room POST OFFICE CARRIER POST OFFICE CLERK 7
  8. 8. Superbill You New Patient Information ________ ________ Life of a Real-Time Claim 7 to 21 Days Clearinghouse Insurance Carriers 8
  9. 9. Smooth Process: Impacting Challenges Failure to pre-authorize claims Not discussing financial obligation w/ patient Check/ Update patient information Inaccurate or incomplete superbill Failure to make sure all patients checkout
  10. 10. Cash-Flow Leaks Claims are not filed promptly Patient info is not accurate/ up-to-date Claims are sent to wrong place Coding problems – high rejections Properly prepared claims> not paid by insurance / CMS for 30-120+ days Patients owe balances – you become the “bank” Patients can’t / won’t pay> write-offs
  11. 11. Get claims paid in 7-21 days
  12. 12. Problems Plaguing Medical Billing Rejections – 30% national average Causes: 1. Procedure not covered 2. Inaccurate coding 3. Under coding 4. Human error: typos, transposition of numbers, etc.. Slow Payments – 45-60 days national average Causes: 1. Overwhelmed staff, slow submissions 2. Sluggish submissions by outsourced biller 3. In effective rejected claims management
  13. 13. Problems Plaguing Medical Billing Abandoned claims Causes: 1. Not enough time to focus on resolving 2. Person assigned gives up Doesn’t believe it matters Assigns to “Porsche file” – do you have one? Medical billing software upgrades Causes: 1. All Software programs require costly maintenance Changes in CPT and IDC-9 codes Are you keeping up with the upgrades? What about your 3rd party biller (upgrades)?
  14. 14. Solutions 1. Implement Web-Based system/ service Claims completed on-line Processed in “Real-Time” Not necessary to send in batches eliminates step Automatic “Real-Time” error checking Reduce rejection rate from 30% to 2% Code + HIPAA updates are made as they occur Eliminate costly upgrades Save hundreds/thousand $$$/ year Eliminate staff down-time
  15. 15. Solutions Web-Based (cont) “Real-Time” Eligibility (our system) Improve check-in process Reduce staff down-time/improved office productivity Address financial obligation w/ patient All claims/data are secure & encrypted Routine secure back-up (our system) Most systems > every 5 minutes Security exceeds “hacker proof standards” used by financial institutions (our system) 24/7 access/ visibility to your A/R Home, office, travel, etc… Password protected Assign access levels by responsibility Appointment scheduler “Real-Time” Reporting
  16. 16. Solutions 2. Establish disciplined billing process Evaluate/ update Superbill Codes quarterly All claims submitted within 24 hours of patient visit All rejection/ errors corrected/ resubmitted within 48 hours Identify reason for errors, correct and implement into process
  17. 17. Solutions 3. Establish “Denial Management” team/ process Unresolved claims = direct/ immediate impact to cash-flow HIGH PRIORITY: Review everyday Establish automated tracking system Does you system/service have this? Work the claim= identify issues, formulate corrective action, update process for future claims “Real-Time” eligibility – does your system/ service have this?
  18. 18. Increase Per Claim Profits
  19. 19. Increase Per Claims Profits When does coding count? When you want to get paid correctly
  20. 20. Increase Per Claims Profits Why coding is so important: No payments are made without coding All procedure codes carry monetary value It is the primary reason why most claims are rejected Lost per claim profits are caused by incorrect/ under coding
  21. 21. Increase Per Claims Profits Improve your per claim profits Consider Certified Coding service 24 hour turn-around services available Virtual Maximize your RVU pay-out (15-30%) Enhance your current A/R cash-flow: Augment with current system/service Insure claims are processed correctly Faster insurance payments> improved cash-flow
  22. 22. MBS 24 Hour Remote Coding Service Physician’s office faxes Enter •a copy of the Claims into chart Billing OR System •Copy of the Coding superbill with OR Cycle the diagnosis Electronically Coders Assign sent to Return Coded Codes certified Records back to the coders Diagnosis, Procedures, Physician Supplies
  23. 23. What do you do when the Patient Can’t Pay In Full?
  24. 24. Patient Can’t Pay In Full Doctors only collect 49% of what patient’s owe them (national average) Current economic conditions drive the need for payment plan options Distinguish between people who don’t want to pay and those who can’t pay in full. Rule #1: “Do not chase your money”
  25. 25. Patient Can’t Pay In Full Your options for those who need help Automatic credit card payments Con: can become tough to manage if no automated system is in place 3Rd Party lenders – Medical loans Cons: patient must be credit worthy Pre-Authorized payments: Best option: No cost to practice No credit applications No patient invoicing Mutually agreed upon / affordable monthly payments Not EFT – eliminates patient concerns about account access Consistent cash-flow/ no chasing your money
  26. 26. Eliminate Write-offs/ Recover Lost Profits
  27. 27. Collections Two primary ways commonly used 1. Office staff makes calls / sends letters Can work, difficult to stay on-top of consistent execution 2. Hire collection agency Not ideal for doctors do to average claim size Work on high % cost rate (30-50%) Not all claims/accounts are worked equally – largest get the attention Low overall recovery rate (10-14%) Negative impact on patient relations
  28. 28. The Hidden Secret to Collections FACT: The longer you allow you’re A/R aging to extend, the more difficult/ costly it will become to collect. Solution Establish a system that starts early in the collection process (60-120 days) Avoid traditional collection agencies Implement a “automated collection system”
  29. 29. Automated Collection Complete automated collection services available armed with the threat of a retained attorney; Litigation; Credit bureau set-up / reporting Benefits: All claims worked equally, regardless of size Allows you start any time within you’re A/R aging time-line Recovery rate = up to 3 times greater Recovery cost = 1/3 the cost (10%) Money paid directly to practice, not to any agency Maintain patient relations
  30. 30. The RAC Are you prepared? Recovery Audit Contractor (RAC) Independent contractors, hired by CMS, authorized by Congress 3 state pilot program in place since 2003 (hospitals only)– over $1B of overpayments collected RAC objectives: Documentation and coding inconsistencies Overpayments (& Underpayments) made to the providers based on the findings Clear documentation to support the medical necessity of the services being provided or dispensed
  31. 31. How to Prepare Your Practice • Perform an independent baseline audit assessment to identify areas of non-compliance with Medicare/Medicaid rules • Identify any corrective actions required for compliance • Implement any required changes to stay in compliance • Establish “Go-To-Team” – RAC Consultant & Certified Coders
  32. 32. MBS Support Base-Line Audit Process MBS – Your “go-to” team •RAC Audit Management •Random selection •RAC Findings Review of 50 office notes •RAC Appeal Web-based Training Fax to HIPAA Medicare secure site (iDocumentsNow) •All Medical Specialties Documentation & for certified •Designed for Physician Coding coders to •Training for your Benchmark Audit review coding team/ staff Audit Report Documentation and coding Compliance audit performed by certified coders
  33. 33. Considering an EMR?
  34. 34. Considering an EMR? Consider Web-based Same benefits as web-based billing Safe, low cost maintenance Virtual – view from office, home, travel, etc. Is your current billings system/service EMR compatible? Medicare incentive Implement by end of 2010 Incentive: $42K 2011: $18K; 2012: $12k; 2013: $8k; 2014: $4k “meaningful use” = incentive qualification System must be certified by HHS (Health and Human Services) Established standards for Certification by HHS are still pending
  35. 35. Services Med-Billing Solutions, LLC Services: EMR i-Billing : Full Service, State-of-the-Art EMR i-Solutions : One-stop solution RAC Base-Line Audit Services Complimentary RVU-MAX - Coding Services (24-Hour) Practice Analysis MaxCollect™ Profit Recovery Patient Payment Plan™
  36. 36. Thank You Med-Billing Solutions, LLC Stephen St. Gelais MBS Consultant 805-428-4566 sstgelais@med-billingsolutions.com www.med-billingsolutions.com
  37. 37. Introduction Medical Billing & Coding Financial Services Stephen St. Gelais Edward Albrecht Certified Public Acct. Marketing & Advertising Kristine Vail Bob Charney Banking & Finance Information Technology Alice Madrid-Neumann Terry Schladetzky Business Brokerage Real Estate Robert Fiance Linda Brown Legal Joining us soon… Mark Pearl Medical Waste, Construction, and more… Flagship Charity: Dedicated to serving the "OwieBowWowie and Friends Foundation” medical community Gina Gippner-Woods

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