Projects Archive

BACKGROUND

After deferring implementation dates multiple times, the US Department of Health and Human Services issued a final rule concluding October 1st, 2015 as the new compliance date to transition to the ICD-10CM code. Doctors and clinical staff were overwhelmed by the various changes they would have to make to their coding practices in order to get paid accurately for services rendered.

WHAT WE DID

We began an internal ICD-10 education process more than a year before the final rule date. The trainers began training others in the organization over several months to ensure that we help our clients transition to the new coding mandate. We developed specialty specific training curriculum which involved scenario-based ICD-10 cases that dealt with the services that our clients rendered routinely.
As we inched closer to three months of the final rule date, we trained our clients (doctors, clinical and administrative staff members) on ICD-10 as it pertains to their practices. We further provided educational material that they could use to get up to speed on codes that they needed to help us bill correctly.

OUTCOMES

While practices across the US faced challenges in getting paid correctly post-ICD10, ALL our clients received payments in time with zero denials related to ICD-10.

BACKGROUND

Physician Quality Reporting System (PQRS) is a quality reporting program that encourages individual eligible professional (EPs) and group practices to report information on the quality of care to Medicare. While Medicare provided incentives until 2014 for PQRS compliance, the entity started penalizing doctors if they failed to comply 2015 onwards. Naturally, physicians were overwhelmed trying to figure a seamless way to stay compliant with Medicare.

WHAT WE DID

We educated clients what PQRS requirements were. We analyzed their billing patterns and helped them select relevant measures that suited their specialty. On instances where we couldn’t find suitable measures, we coordinated with the PQRS help desk to help our client select appropriate measures. We worked with third-party software systems (where applicable) to automate PQRS submissions.

OUTCOMES

All our participating clients achieved 100% PQRS compliance.

BACKGROUND

The client is a Fortune 100 global medical devices manufacturer. The product manager from one of the divisions approached us for developing mobile apps that were to be launched with a premium knee surgery device. The app had to strictly adhere to the company’s compliance guidelines as well as maintain patient confidentiality.

WHAT WE DID

Our Health IT team developed native apps on iOS and Android platforms. We coordinated with various stakeholders to ensure compliance at every stage of product development. Further, we supported design enhancements of the app and incorporated data encryption standards to secure the flow of data. Our partner developed the entire brand identity for the app.

OUTCOMES

The app was launched successfully in both Google Play and Apple app stores and is greatly recognized as an innovative use of technology within the client’s enterprise. We also helped the organization’s Southeast Asia division adapt the app in four languages for a region-wide rollout.

This is a New Jersey based medical group.

THE RULE

Under the Meaningful Use program, CMS (Centers for Medicare and Medicaid Services), an agency within the Unites States Federal Government, provides financial incentives to eligible professionals and hospitals for adopting certified electronic health record (EHR) system and demonstrating EHR usage in accordance to the standards specified by the government.

PROBLEM

We were working with New Jersey based medical group, helping them demonstrate Meaningful Use compliance. CMS randomly selected a physician from the group for an audit and appointed a CMS affiliated contract auditor to review the case. Failure to comply would result in loss of incentive payment for the physician and a high probability of the entire group being audited for the subsequent years. The auditor requests system usage logs, EHR reports, and email exchanges with third party vendors such as the state Immunization Information Systems (IIS) to ensure compliance.

PROCESS

The auditor scrutinizes each measure under the Meaningful Use program and requests specific documentation that demonstrates compliance. The group administrator approached our compliance team to assist them with the audit process. We initiated the process by verifying group and EHR vendor privacy and security documentation to build a strong case. Working with the EHR vendor proved to be a major bottleneck due to unavailability of consistent support and the complex nature of the software itself. We educated the medical group on the audit process and continuously followed up with the IT consulting agency employed by the group and the EHR vendor, for gathering compliance documentation.

RESULTS

The auditing agency passed all measures, except one, due to insufficient EHR information. We appealed directly to CMS to reconsider the application. Upon thorough review, CMS upheld auditor’s decision and the physician is now being considered for successfully demonstrating Meaningful Use compliance and financial incentives.

This is a pathologists-owned and operated, diagnostic company located in Flushing, New York. The lab offers a variety of services that include histopathology, immunohistochemical analysis, cytology, urine analysis, and molecular pathology.

CHALLENGES

‣ Establishing an entirely new lab.
‣ Setting up practice management system for billing.
‣ Incorrect patient insurance information leading to high denials.
‣ Data extraction from Lab Information System (LIS).
‣ No access to paper remittances for timely payment reconciliation.

SOLUTION

‣ We established a process for daily patient information extraction and verification.
‣ Setup Direct Deposits and Electronic remittance for major insurances for quick payments.
‣ Negotiated contracts with TPAs and established global agreements for higher reimbursements.
‣ Started sharing billing summary with the business owners on a weekly basis.
‣ We created carrier specific coding and billing guidelines for clean claims submission.
‣ We also assisted the lab in building process for managing patient receivables.

RESULTS

‣ Negotiations with TPAs resulted in agreements for 90% payments.
‣ 15% increase in payments from two major insurances due to clean billing.
‣ Overall collections improved by 31% between 2014-15.
‣ Closed 90+ insurance AR at 9% by the end of 2015 (industry average for 120+ insurance AR is 12%).
‣ 2x increase in the samples screened due to streamlined operations.

This is a three doctor dermatology practice specializing in general and cosmetic surgery procedures. As a newly setup practice with single physician, the practice was keen on strategic business expansion and were particular about building streamlined operations.

EXPECTATIONS

‣ Getting credentialed with all major insurances.
‣ Verifying visit related patient information before the date of service.
‣ Same day claim submission with high accuracy.
‣ Timely denial tracking and maintaining practice performance reports.

SOLUTION

‣ Credentialing: We initiated the credentialing process on behalf of the practice by identifying top insurances, filling relevant application forms, document consolidation and regular follow ups. We shared the credentialing status with the practice regularly.
‣ Adding new location: We helped the practice with the administrative requirements involved in opening new practice location by contacting all major carriers and updating new practice address to avoid payment disruption.
‣ Coding: Created insurance specific coding guidelines to revalidate procedure compatibility and modifier usage, prior to submission of claims. This resulted in high clean claims submission and better first pass ratio.
‣ Performance tracking: We introduced a web based performance tracker sheet. Summary of claims submitted, payments received and denials were update daily. Bifurcated billing/charges summary report of all three providers with their cosmetic and medical procedures was shared with the practice regularly.
‣ Process optimization: We implemented a daily denial management process reduce the reconciliation time to two days. Realtime eligibility and benefits verifications utilities were used for walk-in patients. We devised patient collections plan and sent outstanding balance statements to patients daily.

RESULTS

‣ The practice successfully expanded, currently housing three physicians and three assistants.
‣ Closed 90+ insurance AR at 3% at the end of 2015 (industry average for 120+ insurance AR is 12%).
‣ Completed credentialing for all three providers.
‣ Average collections increased from $50K to $220K.
‣ AR days maintained between 23 to 25 days.

This is a five doctor gastroenterology ambulatory surgery center (ASC) specializing in Upper and Lower GI procedures. The center is equipped with an in-house lab. The doctors also perform procedures in hospitals.

CHALLENGES

• The center struggled with an inflated AR due to high denials, disorganized AR management process
• Use of multiple archaic software systems for ASC billing and procedure billing
• Crucial protocols for upfront patient collections and patient AR were missing
• Difficulty to obtain patient benefits and procedure authorizations promptly causing further denials

SOLUTION

• Transitioned the center to a modern day cloud based practice management system
• Extensively worked on old AR and recovered outstanding payments
• Restructured claim charge amount according to industry standards
• Deployed same day denial management process coupled with regular follow ups
• Identified underpaying TPAs and set up a global agreement for all pathology and anesthesia claims
• Suggested new procedures that could be performed in an ASC setting in a profitable manner
• Patient eligibility and benefits verification 5 days prior to the date of service
• Helped the center setup upfront payment collections process

RESULTS

• Overall insurance AR for the center dropped by 27%. Currently stands below 10%
• AR days significantly reduced from 39 days to 25 days
• Overall collections improved by 23% year on year
• Global agreement resulted in $400K improvement in revenues

CHALLENGES

• Inflated insurance & patient AR
• Denials for referrals and authorizations
• Implementation of EHR
• Integration of EHR with hospital lab system

PROCESS

• Eligibility information provided to practice daily
• Electronic remittance set up for 90% insurances
• Daily denials tracked and reconciled
• Seamless integration of EHR within the practice
• Onsite and remote training and support for EHR

RESULTS

• Insurance AR under currently 5%
• 120+ overall AR currently at 4.82%
• Average monthly collections increased by $70,000 within a year
• Negotiated rates for Remicade infusion resulting in higher reimbursements
• One of the few physicians’ to receive MU Stage 1 incentives using a mobile EHR

“I have portability. My records are available in office, in hospital, at home and on the go”

CHALLENGES

• Physician performs some of the most advanced gastroenterology procedures
• Used an archaic practice management system
• Clean claim submissions
• Managing accounts receivables and controlling denials

PROCESS

• Created coding alerts and updated encounter forms
• 100% patient eligibility two days prior to the date of service
• Insurance follow-up within 20 days
• Detailed analysis on denials and factors influencing revenues
• Setup patient receivables process with customized patient statements as per practice requirements

RESULTS

• Average percentage of collections increased by 8%
• Transitioned practice to a web based practice management system, conducted onsite training
• Total AR days reduced to less than 30 days
• 28% increase in collections in the year of transition
• Consulted the practice on pathology billing increasing the reimbursement by $150,000 annually

“We see checks coming in 2-3 weeks, which was unheard of…”

CHALLENGES

• Physician used the billing department at the hospital getting insufficient focus
• Inconsistencies in billing process
• Poor quality customer support with practice management system
• Delayed reimbursements for services provided at hospital and at Department of Corrections

PROCESS

• Established a daily billing process at the practice
• Conducted 24-hour clean claim submissions
• Rectified the coding process and alerted physician on denials and accepted coding norms
• Took over benefits verification process
• Negotiated reimbursement rates leading to higher payments
• Setup capitation contract for global payments

RESULTS

• Collections increased by $314,000 after transition
• AR days reduced from 60 to 45 days
• Faster and higher reimbursements from hospital claims
• Transitioned practice to web based practice management system
• Set up propriety analytics portal providing better management control
• Collected old claims worth $45,000 (from IHS) at 100% of charge amount

Improved accuracy of hospital patient data capture and increased annual collections by $314,000

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