Get More Money Faster

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“

Real Estate

Linda Brown

Business Brokerage

Robert Fiance

Joining us soon…

Medical Waste, Construction, and more…

Legal

Mark Pearl

Information Technology

Terry Schladetzky

Banking & Finance

Alice Madrid-Neumann

Flagship Charity:

"OwieBowWowie and Friends Foundation”

Gina Gippner-Woods

Marketing & Advertising

Bob Charney

Certified Public Acct.

Kristine Vail

Financial Services

Edward Albrecht

Medical Billing & Coding

Stephen St. Gelais

Introduction

Dedicated to serving the medical community

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?

The Cash Flow Pipeline

5

Getting & KeepingPatients

CollectingMoney

DeliveringServices

ReducingExpenses,

Losses

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

Jersey 0.00 0.00 0.00 0.00 125.00 125.00

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%

New PatientInformation__________________

LEDGERCARD

SUPERBILL

Bookkeeper

DOCTOR

RECEPTIONIST

BILLER

CLAIM

INSURANCECHART

ID CARD

SIGNEDAUTH.

POSTALCARRIER

LOCALPOST OFFICE

POST OFFICE

INSURANCECOMPANY

Mail RoomCLERK

CLAIMS ANDATTACHMENTS

DATA ENTRY CLERK

CLAIMSPROCESSOR

ACCEPTEDCLAIMS

REJECTEDCLAIMS

Mail RoomCLERK

POST OFFICELOCALPOST OFFICE

POSTALCARRIER

DOCTOR’SOFFICE

Life of a typicalMedical Claim30 to 120 Days

7

New

Patient

Information

________________

Superbill

InsuranceCarriers

Life of aReal-Time Claim

7 to 21 Days

Clearinghouse

You

8

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

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

Get claims paid in 7-21 days

Problems PlaguingMedical 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

Problems PlaguingMedical 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)?

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

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

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

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?

Increase Per Claim Profits

Increase Per Claims Profits

When does coding count?

When you want to get paid correctly

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

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

Coding Cycle

Physician’s office faxes •a copy of the chart

OR

•Copy of the superbill with the diagnosis

Electronically sent to certified coders

Coders Assign

Codes

Enter Claims into Billing System

Return Coded Records back to the

Physician

OR

Diagnosis, Procedures, Supplies

MBS 24 Hour Remote Coding Service

What do you do

when the Patient Can’t Pay In Full?

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”

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

Eliminate Write-offs/ Recover Lost Profits

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

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”

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

The RACAre 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

How to Prepare Your Practice

• Perform an independent baseline auditassessment 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

MBS SupportBase-Line Audit Process

Medicare Documentation &

Coding Benchmark Audit

•Random selection of 50 office notes

Fax to HIPAA secure site

(iDocumentsNow)

for certified coders to

review

Documentation and coding Compliance audit performed

by certified coders

Web-based

Training

AuditReport

MBS – Your “go-to” team•RAC Audit Management•RAC Findings Review•RAC Appeal

•All Medical Specialties•Designed for Physician

•Training for your coding team/ staff

Considering an EMR?

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

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

� RVU-MAX - Coding Services (24-Hour)

� MaxCollect™ Profit Recovery

� Patient Payment Plan™

Complimentary Complimentary

Practice AnalysisPractice Analysis

Thank You

Med-Billing Solutions, LLC

Stephen St. Gelais

MBS Consultant

805-428-4566

sstgelais@med-billingsolutions.com

www.med-billingsolutions.com

Joining us soon…

Medical Waste, Construction, and more…

Information Technology

Terry Schladetzky

Banking & Finance

Alice Madrid-Neumann

Real Estate

Linda Brown

Business Brokerage

Robert Fiance

Flagship Charity:

"OwieBowWowie and Friends Foundation”

Gina Gippner-Woods

Legal

Mark Pearl

Marketing & Advertising

Bob Charney

Certified Public Acct.

Kristine Vail

Financial Services

Edward Albrecht

Medical Billing & Coding

Stephen St. Gelais

Introduction

Dedicated to serving the medical community