Projects Archive

ABOUT

The client is an urgent care facility in Michigan.

CHALLENGES

The group was non-par with Blue Cross PPO plan leading to denials, which the facility was not aware about. Further, payments were mailed to an older address that the primary doctor was associated previously.

WHAT WE DID

We coordinated with Blue Cross PPO and determined that under the specific plan the insurance company did not allow for groups to be credentialed. We then worked towards credentialing individual doctors so that payments can be received directly. After credentialing was achieved, the insurances continued to mail payments to the doctor’s older address. We worked with the insurances to update their databases so that payments were correctly mailed to the right location.
Further, we helped successfully setup an interface between the EHR (Practice Fusion) and AdvancedMD (the practice management system) used at the facility.

LIFE WITH NEXTSERVICES

Urgent care is a rapidly growing area of medicine with great competition. Sometimes establishing a new facility requires navigating sticky issues with credentialing as it happened with this client. The experience of our transition team helped quickly zero in on key issues so that there’s minimal disruption with payments. The facility continues to enjoy the benefits of methodical billing practices that our team brings.

ABOUT

The client is a OB/GYN who left her hospital job to start a private practice in Massachusetts.

CHALLENGES

Setting up a new practice is a tough challenge in itself but there were several specific challenges faced by the doctor.
1) Hospital sent notices to all carriers that the doctor wasn’t part of their system resulting in billing denials.
2) Billing process including coding, was required to be established.
3) EHR needed to be made suitable for OB/GYN and rolled out.

WHAT WE DID

Our team established the entire billing process from ground-up and rolled out enki EHR helping the doctor establish herself after leaving the hospital.
1) We re-credentialed her with all major insurance companies resulting in minimal financial disruption.
2) Along with implementing a complete billing process from charge entry to Accounts Receivable follow up, we worked towards building a coordinated OB/GYN coding guide that helped the team bill accurately.
3) We rolled out enki EHR in a short time and customized enki modules for OB/GYN as per the doctor’s preference. We also developed uni and bi-directional interfaces with the hospital’s lab and with Quest Diagnostics. The entire implementation was completed remotely and fairly quickly.

LIFE WITH NEXTSERVICES

Regardless of specialty, location and credentialing status, we were able to help this doctor establish her new practice smoothly. We bring deeply experienced billing practices to all our engagements – this offers much needed financial stability for new practices. enki EHR, our cloud/mobile based electronic health record platform makes it easy for a speedy rollout, with minimal disruption and training requirements of staff.

ABOUT

The client successfully established a new dermatology practice in a metropolitan area in Pennsylvania.

CHALLENGES

Breaking away from a larger group, the client established a new dermatology practice in metropolitan Pennsylvania. She preferred using EMA from Modernizing Medicine as an electronic health record (EHR) but wanted us to integrate it with AdvancedMD, the practice management system that we use. The practice also required that coding be regularly reviewed for appropriate payments from insurance companies. As a new practice, it was imperative that money came in quickly to enable sustenance and growth.

WHAT WE DID

We methodically identified and implemented several protocols that helped the dermatology practice succeed in a tough metropolitan market. Integrating EMA and AdvancedMD ensured that charges automatically flowed from one system to the other. We review every single claim for coding accuracy and appropriate modifier usage that is critical for payments. We submit charges on the same day of receipt that dramatically reduces lag days for payments. We execute a patient collections process as agreed by the practice. Further, we worked on all old AR and recovered previous balances.

LIFE WITH NEXTSERVICES

Billing discipline requires that we put extraordinary focus on doing the small things well that add up to provide financial stability required for growth. This sometimes means doing simple things well, such as a weekly call between the administrator and the billing team. The NextServices team strives for predictability in billing outcomes through innumerable, frequent actions that repeat every single day.

ABOUT

The client split from a neurology group to setup her own practice in metropolitan Georgia. We helped the client in a variety of ways to establish herself.

WHAT WE DID

1) Credentialing. We completed credentialing with all major insurance companies successfully. This was the first step to helping the doctor getting setup on her own.
2) EDI/ERA/EFT utilities. Once the practice management software was established, we setup EDI, electronic remittance (ERA) and electronic fund transfer (EFT) utilities to help with timely payment.
3) PQRS compliance. We helped the practice demonstrate Physician Quality Reporting System (PQRS) compliance and earn incentives through the program.
4) ICD-10CM Training. We trained the practice in ICD-10CM coding and coordinated with the team to ensure zero ICD-10CM denials after coding transition in October 2015.
5) Meaningful Use Compliance. We consulted with the practice for Meaningful Use (MU) and helped them demonstrate MU compliance.
6) Change of location compliance. When the practice changed their location twice, we worked with the insurances to update address change information and ensured that payments are not disrupted.
7) Botox tracking. We developed a tracking mechanism for expensive Botox injections to ensure complete payments on these claims.

LIFE WITH NEXTSERVICES

Neurology is a complicated sub-specialty of medicine. Setting up a medical practice in today’s environment doubles the complexity of running neurology clinic. We helped the doctor successfully establish herself in tough metropolitan area by helping in variety of ways beyond billing.

ABOUT

The client is a neurology clinic based in Georgia.

CHALLENGES

Coding denials. With so few neurology coders around, the biggest challenge that the practice faced was denials through inaccurate coding. Further, coding guidelines for neurology are complicated subject to frequent changes. Risks of compliance audit are also high.

WHAT WE DID

Given that neurology is an arcane sub-specialty, it was important for our coders to identify what insurances in Georgia expected for certain types of procedures and where the practice faced continued denials. Once we figured this out, we developed coding guidelines that helped the neurologist accurately represent her encounter with the patient. We also helped the practice navigate the Physician Quality Reporting System (PQRS) and avoid associated penalties.

LIFE WITH NEXTSERVICES

Not only did the NextServices team ensure neurology coding success for the practice, we also trained the doctor on ICD-10CM coding and helped the practice achieve zero denials in ICD-10 coding.

ABOUT

Two large groups on the east coast of US decided to merge over the period of a year. This had significant implications for billing. Here’s how we helped.

CHALLENGES

These were the following steps we took:
1) Risk analysis. We conducted a detailed risk analysis covering areas impacting billing such as common Tax ID generation, working with top insurances that the group would participate with and identifying all possible areas for payment disruption.
2) Credentialing. We initiated and completed credentialing for all top insurances successfully.
3) Merging of software systems. Our technical team worked with the practice management software vendor to combine office keys of both groups to create a unified group without disrupting past billing records.
4) New interface with the EHR vendor. We worked with the EHR vendor to establish an interface for the new unified practice management system and the merged EHR.
5) Contract negotiation. We gathered all essential documentation required for negotiating higher contracts for the super group.
6) Operational policies. We helped them prepare operational policies to streamline billing updates and avoid any overlaps in administrative processes.

WHAT WE DID

We first understood and documented the various requirements that each end client had. This helped us establish a repeatable process around global billing, technical component billing with specific modifiers, insurance specific billing, end client reporting and invoicing methods.

LIFE WITH NEXTSERVICES

A merger of any kind involves a great degree of complexity and is wrought with challenges. One of the biggest reasons why mergers fail is because back-end systems that ensure cash flow are disturbed. Our team worked hand-in-hand with both groups operationally and technologically that resulted in a smooth and outstanding merger. Today, the super group enjoys the benefits of the merger in terms of saved costs and a streamlined process while we continue to guarantee their financial success everyday.

ABOUT

The client is a rapidly growing pathology lab in California with physician practices as its clients. Our client gets paid based on lab samples analyzed for those physician practices.

CHALLENGES

The client entered into various agreements with physician practices (its clients) that impacted how billing was executed. Some required global billing, some required professional billing with specific modifiers, some others required that the end clients bill themselves while the lab would submit invoices to the practices later.

WHAT WE DID

LIFE WITH NEXTSERVICES

Complexity remains so only when a process is not established. Our team works with clients to help them simplify systems that ensure relentless repeatability. This helps clients reduce the risk of uncertainty and gives them the flexibility to take on the challenges of growth.

ABOUT

The client is a dermatology group based in Illinois.

CHALLENGES

1) Ongoing denials due to authorizations and referrals. The client faced continued denials because they lacked a process to collect authorizations and referrals in time. This created a significant bottleneck towards payments after claims were submitted and insurances demanded authorization numbers and referrals.
2) Huge A/R backlog. Inflated AR due to lack of medical record information. $160,000 was stuck in old Accounts Receivable because suitable information was not provided to insurances in time.

WHAT WE DID

After we started, it took several weeks to coordinate and tune processes on the client’s end. We even faced challenges of scheduling a weekly call to square away denials. However, through persistence we streamlined the group’s billing process by doing the following:

1) We took ownership of obtaining authorizations and referrals 2-days prior to the date of service. This process immediately closed the leaky tap on denials and resulted in an upswing in collections.
2) We increased the number of calls that went out to insurance companies to follow up on old claims. This effort resulted in closing the loop on old, inflated AR.

LIFE WITH NEXTSERVICES

Dermatology practices greatly depend on patient satisfaction. When claims are denied because of a lack of billing process, it not only adds financial pressure to the practice but also results in their patient customers receiving avoidable bills (that should’ve been originally paid by insurances).

We fully realize that billing is not a one time streamlining activity and can slip anytime when it doesn’t get due attention. Our team works to ensure that the client wins every week.

ABOUT

The client is associated with an endoscopy center in New York.

CHALLENGES

1) Lag in sending charges. Administrators struggled to coordinate with doctors to submit charges in time resulting in losses due to timely filing.
2) Denials from non-participating insurances. While insurances encouraged negotiations earlier, they stopped paying non-par claims after a few years creating losses for the center through anesthesia claims.

WHAT WE DID

1) Streamlining billing: We worked daily with the endoscopy center’s staff to ensure we receive charges in time. Over a period of time, the process of billing was slowly streamlined resulting in timely claim submissions and payments.
2) Contracts with insurances: We worked with two of the top 5 insurances to help the center achieve contracting status. This resulted in an immediate boost in revenues saved from losses due to a non-par status. Electronic remittances (ERAs) and Electronic fund transfers (EFTs) ensure quick payments from these insurances.

LIFE WITH NEXTSERVICES

Through persistence and focus towards a streamlined billing process, insurance Accounts Receivable (A/R) above 90 days is maintained at 7%, significantly lower than industry averages of 14%.

ABOUT

The client is a healthcare organization focused on health promotion through cardiovascular health.

CHALLENGE

The client required us to integrate an EHR with the practice management system we use (AdvancedMD). But while contracting with the EHR vendor, the client accidentally signed Medicare EDI agreements. This led to payments going into the wrong system – the EHR, whereas, billing was done by AdvancedMD – creating discrepancy in both systems.

WHAT WE DID

Our team identified the problem of wrong payments because incorrect contracting and notified both the client and Medicare. We further fixed the error by helping the client execute a new EDI agreement and ensuring a smooth coordination with both the EHR vendor and the practice management system.

LIFE WITH NEXTSERVICES

After reconciling the problems, the practice now receives correct payments which has helped them function without any worry of further payment disruption. Sometimes, it is the smallest things can lead to unnecessary escalations disturbing the rhythm of the business. Our team is extremely vigilant of business pitfalls and steps in to go the distance to resolve anything at hand.

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