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Regulatory and Practice Regulatory and Practice Management ServicesManagement Services

Daniel L. Johnson, CPC, CPC-H

Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First

Practice Management ServicesPractice Management ServicesPractice Management ServicesPractice Management Services

• Total Practice Management

• Practice Evaluations

• Revenue Cycle and Fee Schedule Analysis

• Strategic Planning

• Business Plans

• Practice Valuations

• Managed Care Contracting

• Presentations

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Practice Management ServicesPractice Management ServicesTotal Practice ManagementTotal Practice Management

Practice Management ServicesPractice Management ServicesTotal Practice ManagementTotal Practice Management

Description: For the approximate cost of a full-time employee, MMHSI can oversee and manage the day-to-day operations of a medical practice.

Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First

Practice Management ServicesPractice Management ServicesTotal Practice ManagementTotal Practice Management

Practice Management ServicesPractice Management ServicesTotal Practice ManagementTotal Practice Management

• Consulting and management support of a medical practice to include but not limited to the processing of insurance claims, accounts receivable, accounts payable, and other reporting as may be required by the physicians.

• Monthly on-site visits by a member of the Consulting Staff of MMHSI for oversight. Monthly reporting on the operations of the office will be provided.

• Consulting support for CPT/ICD-9/Medicare/Medicaid and other Third Party Payers as related to physician billing.

Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First

Practice Management ServicesPractice Management Services Practice EvaluationsPractice Evaluations

Practice Management ServicesPractice Management Services Practice EvaluationsPractice Evaluations

Description: Assesses practice operations and management. An on-site assessment of 2-3 days is necessary and written report of findings and recommendations are provided.

Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First

Practice Management ServicesPractice Management Services Practice EvaluationsPractice Evaluations

Practice Management ServicesPractice Management Services Practice EvaluationsPractice Evaluations

• Assess billing operations, collections, and accounts receivable;

• Coding and documentation review;• Comparative Profile Analysis• EO(M)B Review (review of denied services)• Patient Mix Analysis• Patient Flow• Staffing Analysis• Regulatory Compliance Review

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Practice Management ServicesPractice Management Services Revenue Cycle and Fee Schedule Revenue Cycle and Fee Schedule

AnalysisAnalysis

Practice Management ServicesPractice Management Services Revenue Cycle and Fee Schedule Revenue Cycle and Fee Schedule

AnalysisAnalysisDescription: Review billing, collections, and accounts receivable process and makes specific recommendations for improvement. Current Fee Schedule is reviewed and compared to our extensive database of physician fees. Recommendations are made to change charges to current market levels.

Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First

Practice Management ServicesPractice Management ServicesStrategic PlanningStrategic Planning

Practice Management ServicesPractice Management ServicesStrategic PlanningStrategic Planning

• New Business Structures

• Develop New or Updated Management Teams

• Enhance your Business

• Develop New Revenue Streams

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Practice Management ServicesPractice Management Services Business PlansBusiness Plans

Practice Management ServicesPractice Management Services Business PlansBusiness Plans

• New Business Ventures

• Obtaining Capital Investment

• New Practice Startups

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Practice Management ServicesPractice Management Services Practice ValuationsPractice Valuations

Practice Management ServicesPractice Management Services Practice ValuationsPractice Valuations

• Valuations of Hard Assets• Valuations of Intangible Assets (Good

Will)• Evaluation of Regulatory Compliance for

Valuation Purposes• Evaluation of Cash Flow and Collections• Evaluation of Staffing and Expenses• Assign Dollar Value to Your Practice

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Practice Management ServicesPractice Management Services Managed Care Contracting Managed Care Contracting

Practice Management ServicesPractice Management Services Managed Care Contracting Managed Care Contracting

• Evaluation of Current Contracts

• Evaluation and Negotiations of Fee Schedules

• Evaluation and Recommendations for Future Contracts

• Direct Contracting

• Capitation Evaluation

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Practice Management ServicesPractice Management Services PresentationsPresentations

Practice Management ServicesPractice Management Services PresentationsPresentations

• Practice Evaluations

• Revenue Cycle Analysis

• Organization Management

• Managing and Motivating Staff

Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First

Regulatory Compliance ServicesRegulatory Compliance ServicesRegulatory Compliance ServicesRegulatory Compliance Services

• Medicare/Medicaid/Third-Party Payer Audit Defense

• Voluntary Compliance Programs• Individual and Corporate Integrity Agreements• Voluntary Disclosures• HIPAA Compliance Programs• OSHA Reviews/Training/Compliance• Research and Coverage Analysis• New CPT Development• Legal Assistance and Support Services

Because your patients come first.Because your patients come first.Because your patients come first.Because Your Patients Come FirstBecause Your Patients Come First

Regulatory Compliance ServicesRegulatory Compliance ServicesAudit DefenseAudit Defense

Regulatory Compliance ServicesRegulatory Compliance ServicesAudit DefenseAudit Defense

• Consulting Services Related to Disputing Overpayment Demands

• Statistical Analysis• Fair Hearing and Mediation Representation• Administrative Law Judge Hearing Assistance• Attorney Support Services• Research• Audits• Other Analysis as Needed

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Regulatory Compliance ServicesRegulatory Compliance ServicesVoluntary Compliance PlansVoluntary Compliance Plans

Regulatory Compliance ServicesRegulatory Compliance ServicesVoluntary Compliance PlansVoluntary Compliance Plans

• Establish Voluntary Program Designed to Limit Audit/Fraud& Abuse/Whistle-Blower Cases

• Custom Program Designed for Your Practice/Business

• Meets OIG Compliance Guidance

• Annual Auditing and Monitoring

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Regulatory Compliance ServicesRegulatory Compliance ServicesIndividual and Corporate Integrity Individual and Corporate Integrity

AgreementsAgreements

Regulatory Compliance ServicesRegulatory Compliance ServicesIndividual and Corporate Integrity Individual and Corporate Integrity

AgreementsAgreements

• Recognized as Independent Review Organization by the OIG

• Statistically Valid Design and Auditing

• Annual Reporting and Monitoring

• Customized Compliance Program to Meet Integrity Agreement Goals

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Regulatory Compliance Services Regulatory Compliance Services Voluntary DisclosuresVoluntary Disclosures

Regulatory Compliance Services Regulatory Compliance Services Voluntary DisclosuresVoluntary Disclosures

• Mediation with Payers

• Confirmatory Audits

• Corrective Action Plans

• Auditing and Monitoring to Assure Compliance

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Regulatory Compliance ServicesRegulatory Compliance Services HIPAA Compliance Programs HIPAA Compliance Programs

Regulatory Compliance ServicesRegulatory Compliance Services HIPAA Compliance Programs HIPAA Compliance Programs

• Compliance Manual

• Training

• Implementation

• Form Development

• Dispute Resolution

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Regulatory Compliance ServicesRegulatory Compliance Services OSHA Reviews/Training/ComplianceOSHA Reviews/Training/Compliance

Regulatory Compliance ServicesRegulatory Compliance Services OSHA Reviews/Training/ComplianceOSHA Reviews/Training/Compliance

• Initial Safety Evaluation and Report

• Safety Manuals

• Blood Borne Pathogen Manuals

• Training

• Complaint Investigation and Resolution Management

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Regulatory Compliance ServicesRegulatory Compliance Services Research and Coverage AnalysisResearch and Coverage Analysis

Regulatory Compliance ServicesRegulatory Compliance Services Research and Coverage AnalysisResearch and Coverage Analysis

• Complex Coding and Reimbursement Issue Analysis

• National and Local Coverage Decision Research and Analysis

• New or Revised Coverage Determination Development

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Regulatory Compliance ServicesRegulatory Compliance ServicesNew CPT DevelopmentNew CPT Development

Regulatory Compliance ServicesRegulatory Compliance ServicesNew CPT DevelopmentNew CPT Development

• Direct Liaison with AMA CPT Advisory and Editorial Panel

• Single Specialty Society Involvement

• Research and Plan Development

• Presentation and Follow-up Services

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Regulatory Compliance ServicesRegulatory Compliance Services Legal Assistance and Support ServicesLegal Assistance and Support Services

Regulatory Compliance ServicesRegulatory Compliance Services Legal Assistance and Support ServicesLegal Assistance and Support Services

• Fraud and Abuse Defense working with Legal Counsel

• Administrative Law Judge Hearing Assistance

• Expert Testimony

• Auditing

• Research and Analysis