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Billing Services by CardiologyCoder.com In today’s world of significantly reduced reimbursements, complex claims submission rules and fee schedules that are both payer and product specific, practices have to know that they have the expertise and infrastructure to capture every dollar they are owed. They have to know they are maximizing revenues with every claim submission, collecting every dollar. CardiologyCoder.Com is excited to partner with Sound Management and Billing to provide a truly comprehensive reimbursement and compliance solution for your practice. We stand out from other potential solutions by offering a unique combination of philosophy, expertise, service, and competence. Focused on cardiology - The challenges of technology management and maximization, data capture, claims submission, accounts receivable follow-up and staff recruitment are much more acute in cardiology practices. We maximize your cash flow by limiting the types of practices we partner with. This allows us to maintain our expertise in the field of cardiology and to focus all of our resources on the mutual goal of enhancing your revenue and level of compliance. A local company with access that matters - We believe that health care is still best delivered locally. As a result, our client support staff resides in the areas they service. Your account manager will acquire an intimate knowledge of the major payers in your markets, their billing rules and claims practices. We will establish communication channels that allow us to quickly resolve claims-related issues and access key payer decision makers for critical business issues. An aligned fee structure - We price and structure our services in a way that incents us not only to provide you with value, but also to excel on your behalf. A proven transition process – We excel at creating smooth transitions that don’t interrupt our clients’ cash flow. Our goal is to ensure a seamless transition where staff are fully trained and where all interfaces and processes work. Industry leading denial management expertise - Every health care provider deserves and expects to be paid. However, payers continually find reasons to deny, underpay, or delay payment. In the typical practice, up to 20 percent of rejected claims are never resubmitted. Our proprietary denial management software quickly identifies unpaid or inaccurately paid claims and prioritizes them for follow-up. The combination of this technology and an aggressive billing staff quickly stops revenue leaks and allows you to track payment and denial patterns in ways that ensure maximized collections. A metrics approach to management - We believe that data drives understanding and understanding drives outcomes. We use benchmarking, data analysis and regular jointly attended management meetings to communicate practice performance, financial outcomes, and opportunities for improvement with our clients. World Class Compliance Initiative – Jim Collins, President of CardiologyCoder.com will develop, implement, and maintain a Compliance and Revenue Enhancement (CARE) package of services for you. There are three primary benefits offered by a CARE package: 1. Charge Capture: The expansion of service lines offered by today’s cardiology practice has been outpaced only by the complexities associated with billing for these services. Without staying on top of these complexities, practices forfeit much of their hard earned money. The auditing, monitoring, and training components of a Compliance Program frequently identify opportunities to increase revenue. It would not be uncommon for a practice of your size to realize additional annual revenues in excess of one million dollars that would be directly attributable to your Compliance Program. 2. Regulatory Exposure: The regulations that have been developed and revised in recent years have created a hazardous work environment for all physicians and practice administrators. Penalties in excess of fifteen thousand dollars per claim have been established for inappropriate billing and the definition of “fraud” now includes operating a practice in “deliberate ignorance” or with “disregard of the regulations.” A compliance effort will proactively screen for violations of applicable regulations and give us an opportunity to correct identified problems before it is too late. 3. Insurance: The complexity and volume of federal and state regulations virtually guarantee that no physician group will be fully “compliant” with all applicable regulations one-hundred percent of the time. Excessive penalties (civil and criminal) are frequently imposed on organizations that appear to be practicing with disregard for applicable regulations. Maintaining an effective Compliance Program will help reduce penalties in the unfortunate event of prosecution by clearly illustrating the good will of the organization. This will help lower the organization’s culpability score and directly reduce potential penalties. These benefits and more will be realized by your practice through maintaining an effective Compliance Program. The nuts and bolts of what constitutes a Compliance Program are typically reduced to writing in a plan document that must include seven specific functions defined by the Department of Health and Human Services Office of Inspector General. One of the first goals Jim would have in working with your organization would be to make sure it has a plan document that includes these government mandated specifics. However, what make a Compliance Program effective are the actions we will take to identify, eliminate, and prevent activity that exposes you to liability. At the same time, one of the common benefits of a Compliance Program is that organizations frequently identify under billing (procedural and E&M services). These incidences of under billing represent opportunities to increase revenue and establish a Compliance Program as an “investment” rather than an “expense.” AUDITING: • Two procedural audits will be conducted at even intervals through the year that include an average of ten procedures per physician. The types of services included in this audit will be dictated by your unique CPT code utilization profile and designed to include a representative sampling of the major services provided. • Two evaluation and management specific audits will be conducted at even intervals during the year. These will also include ten patient encounters per physician and a mix of office based and hospital based services. • Quarterly physician dashboards will be compiled. These unique graphic analyses compare your billing profile to other cardiologists located in your state. This is similar to the assessment utilized by Medicare auditors to identify audit targets; the insight you’ll gain could help you avoid the audit radar. Findings and recommendations from each audit will be conveyed in graphic-rich written reports. These reports are “physician-friendly” and convey a lot of critical information in a very efficient manner. They will allow you to view findings at the mile-high view and to dive into patient-by-patient detail where desired. Each report will also contain the source documentation (i.e. medical records) used in the audit. TRAINING: Remote web conference training will be provided to you and the appropriate support staff in your office and at Sound Management and Billing after the conclusion of each audit. This training will be designed to cover any concerns identified during the audit and will include several case studies illustrating proper and improper coding and documentation practices. Jim also works closely with you and Sound Management and Billing to develop an effective and accurate charge capture system: encounter forms, super bills, cross check mechanisms, internal controls, etc… The charge capture process will help ensure accurate billing and it will substantially minimize avoidable claim denials. SUPPORT: Mr. Collins will serve as the Compliance Analyst for your organization and be available to answer coding/billing questions during the year, assist with coding for complex cases, and help research coding/billing rules. He will also assist you with responses to audits conducted by outside payers to help protect the interests of the organization. An integrated revenue cycle solution - With Sound Management, you no longer need to spend money on software support, a billing staff, a practice consultant for feedback on financial performance or technical assistance for computers and software. We provide it all with a superior level of service, a genuine familiarity with your practice and the professionalism that makes you confident in our responses. An understanding of your needs - Every practice is different, with different needs. In addition to offering financial outcomes and the best software products, we provide regional insight and proprietary analytical tools that allow our clients to understand their data, performance and outcomes. Platform independence - A practice that chooses to purchase a practice management system is making a huge investment. Unfortunately, sometimes things don’t go as planned and practices find themselves unable to master or manage the system they purchase. At Sound Management, we don’t want any practice to throw away such an expensive asset. With this in mind, we designed our billing and collections service to be compatible with the GE® Centricity system. Can I stay on my current practice management system? That depends. If you are currently using Mysis, Medical Manager, IDX, NextGen or Centricity, you may be able to stay on your current system. If you use another system, we need more information to answer this question. How do I get my billing information to you? Several options are available depending on the product you choose. We access most of our clients' data via secure Internet connections. However, some clients send us paper bills by courier or some other method. How do I know that you are following up on all my claims and not just the easy ones? Your account manager will meet with you weekly by teleconference to review your practice's performance in detail, including your accounts receivable, denials and all other activities. You can also call your account manager, our director of operations or owners at any time with any question you may have. How often do you bill? We bill all clients’ insurance claims and patients statements. We have taken an assertive approach to collecting from patients in user friendly and secure technologies. Your patients can pay on site, via the internet through Instamed or your practices website with bankcards, checks, or health savings accounts. Who receives my collection payments? You have multiple options. You may receive payment at your offices, through a bank lockbox service or through our lockbox service here in Seattle. Our staff will post your payments using your explanation of benefits (EOB) that we will arrange to have delivered to us. Who takes the calls from patients who have questions about their bills? We do. Your practice AR team with your account manager is staffed from 9:00 a.m. to 5 p.m. EST. They can access your data in real time and answer any questions your patients may have. What happens if I decide I no longer want to use your services? Each of our clients is protected by a termination clause for default (i.e., failure to perform). Each contract also has a defined term with an option for the contract to expire when the term ends. |
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