Depending upon the physician specialty, the time interval and billing process can vary. Our organization has several clients whose average billing cycle (from the time services are performed to the time a claim is forwarded to the insurance carrier and a statement is mailed to the patient) is less than 1 day from the date of service.
Start-up costs would amount to the following per practice, which does not include any equipment or other costs associated with the startup:
|System set up, Fee schedule design||$850|
|Carrier registration for electronics||$725|
|Physician credentialing||$125 per hour|
|Physicians contract negotiating||$200 per hour|
|Special reporting||$100 per hour|
We currently have several different arrangements with clients on pricing of services. This could vary between a percentage of revenues collected, flat fee, per hour fee, or per encounter fee. After an assessment of your practices current financial status, both parties will agree upon which option would be best for both organizations.
After all billing information is entered into our system, insurance claims are sent to carriers on a daily basis, with patient statements being mailed to patients weekly. Our organization has extensive experience in contract negotiations with third-party payors. By providing accurate and up to date information, we can assist in negotiating a fair fee for services. This service is provided at physician request and for an additional fee.
Our organization currently bills directly to all carriers that can accept claims electronically. However, there are still several third party carriers that do not have electronic claims capability. In this case, these claims are mailed via the U.S. Postal Service. Please check the McKesson, Emdeon, Capario, or Quadax web site (depending on the system you are using) for a list of the commercial carriers that we currently file claims to electronically.
As previously stated, patient statements are processed and mailed each week.
Our organization has experience in physician credentialing for all insurance and managed care companies. We currently provide this service for several of our clients and routinely assist others in the process. As with our contract negotiations, this service is provided at physician request and for an additional fee.
Currently, our organization processes and mails over 20,000 patient statements a month for our clients. Statements are mailed weekly, with patients being billed on a twenty-eight (28) day billing cycle. For those patients who have insurance, a patient notification statement is the first patient statement sent. This statement is mailed to notify the patient that a claim has been forwarded to their insurance carrier. After this notice, statements are sent on a twenty-eight (28) day cycle, with each dunning message increasing in strength according to the clients aging preferences. Finally, a boldly colored past due notice is sent to notify the patient of pending collection activity. Self-pay accounts are immediately sent a statement notifying the responsible party that payment is due. All statements allow for custom messages to be placed on the statement, in addition to the regular statement dunning messages corresponding to the clients aging cycles.
Physicians Advisory Group, Inc. currently provides the CPT and ICD-9 coding services for physicians. Employees of our organization are members of various industry trade associations. These organizations annually provide education and seminars concerning reimbursement and coding issues. Our employees regularly attend these educational events. However, should the need arise to hire addition coders for other physician specialties, our organization makes every effort to attract industry qualified and trained coders.
Physicians Advisory Group, Inc. has several auditing features established to ensure accurate information is received. First, we receive department logs from hospitals/physicians offices for verification of patient and date of service. Each patient chart is audited against this log to verify receipt from the physician practice. Second, demographic information is received via Electronic Data Acquisition from the hospital for hospital based practices.
This demographic information is audited against insurance card copies that are attached to each patient chart. This is performed at the time charges are entered into the system.
Third, after charges are entered, each chart is then verified against a charge audit report to ensure proper entry into the system. Periodically, a random sample of patient charts are pulled, and coding guidelines are reviewed for proper coding level visits.
Our system has a unique feature that allows for a carriers expected payment profile, by CPT code, to be entered into a practices file for each carrier. When payment information is entered during payment posting, and the expected payment and actual payment do not match, the payment processing personnel are immediately notified so that proper follow-up can occur.
For those patients that are set-up on pre-approved payment plans, our system is unmatched in its monitoring capabilities. Our system allows for printing of payment budget booklets that can calculate payment plans, by number of payments or payment amount per month. This booklet is then organized much like a standard car payment plan. It lists the amount due, date due and running balance of the account. Patients do not continue to receive statements as long as all payment obligations are met. For those patients that do not meet their obligations as promised, a report provides information for follow-up on these accounts.
Physicians Advisory Group, Inc. currently utilizes three different software systems: Healthpac, AdvancedMD, and Epic. All software systems are specifically designed to handle large multi specialty billing operations such as an MSO, or for service bureau operations. Files are structured so that information for each practice can be maintained separately to ensure confidentiality for each practice.
Currently, both systems provide for software enhancements when necessary. However, if carrier demanded, updates will occur immediately. Since our hardware was purchased within the last year, there are no current plans for updates. Should the need arise to require additional hardware, those items will be purchased as necessary.
As previously stated, our system currently receives patient, guarantor and policyholder demographic information from Hospitals, via Electronic Data Acquisition. This feature can be modified to allow for charge information to be electronically transferred, as well as demographic information.
Each practice handled by our organization has been assigned Patient Account Representatives who are responsible for all incoming telephone calls, as well as account follow-up. Each practice has a dedicated number for telephone lines assigned specifically for that practice, if that practice so desires. These lines are answered with a practice individual greeting such as “Thank you for calling the billing office, How may I help you?” We feel that this approach is a more personalized greeting that lets the patient know that we are here to assist them with their questions or concerns.
If the client decides to utilize the service, telephone calls are routinely initiated to patients concerning co-pays, deductibles, insurance information, address corrections, and employment verification. Our philosophy is to contact the patient before the billing process begins. Many times we initiated telephone calls to responsible parties to verify billing information or obtain insurance information that may have been missed during the data capture phase of the billing process at the hospital. By doing this before the billing process begins, we insure that claims are paid on time. For those accounts in which we do receive bad address information, our patient statements contain a “Forwarding and Address Correction Request.” As a result of this statement, the U.S. Postal Services provides our office with corrected bad address information in a timely manner, before the next statement cycle.
Accounts that are turned over to collection are determined by mutual agreement between the client and Physicians Advisory Group, Inc. In most cases, these are done on an aging cycle predetermined in the system software. At forty-five (45) days of aging, an insurance follow-up and self-pay report is generated by the system for account follow-up. Carriers are called to check the status of claims and patients are called to be notified of balances due. Accounts that are ninety (90) days old and contain no activity are placed in a pre-collection status within our system. This feature allows for the system to assign accounts in random order to internal collectors. Once activated by the collector, each account is automatically called up on the computer screen for action. This allows the collector to initiate telephone calls or pre-collection letter activity. The collector then has sixty (60) days to determine what action they wish to take on a specific account. If the collector wishes to continue work with the responsible party payment, they may do so. If the collectors feels that all efforts are exhausted, they may transfer the account to an external collection agency. Management then reviews all accounts ready to go to external collections. If management decides that a specific account should not be turned to external collections, they may elect to do so before transfer to the outside agency. All pre-collection activity is monitored by special reporting that allows management to gauge progress of each internal collector.
The selection of which outside collection agency used is solely up to the client. In most cases, Physicians Advisory Group, Inc. will obtain price quotes from several agencies, however the final decision of the selected agency is made by the client.
We do have the capability to receive prior billing information from a competitive billing system. However, given the vast complexities and differences in systems, most systems will only accept demographic information and balance forward information. We recommend that the current agency be allowed to continue to work down the current accounts receivable for a six (6) month period before a conversion occurs. This allows for cash flow to continue at a steady pace, while decreasing the amount of data that will need to be converted.
Our system has a vast amount of reporting data that can be provided depending upon the client’s wishes. Many of our standard monthly reporting includes Financial Analysis Summary or Detail, Reimbursement Analysis, Activity Report, Accounts Receivable – Overview, etc. Our reports are not just limited to a monthly basis. All reports can be created on-demand, monthly, quarterly, or yearly depending upon the client’s request. We have just completed a special report writing class that allows for the creation of custom reports. This feature of our software called “Report Writer” allows the user to custom design reports based on specific queries of system information.
Currently we have established a performance-based incentive program for all employees involved in working on a particular account. This bonus is designed around company and client philosophy as well as specific goals for accuracy, efficiency, and collectivity. Given all of these factors, an amount of expected collectivity for each client is predetermined. Since our organizations survival for monthly company revenues is based on a percentage for our clients income, we have allocated an amount of these funds to be placed into a bonus pool for distribution to employees. If all client goals are met and company profitability is attained, then the bonus amounts are distributed. This is done on an annual basis. Additionally, if monthly goals are met, management provides minor incentives such as lunch or gifts to the employees to show our appreciation. By allowing our employees to become a part of the accountability to our clients and empowering them in the decision making process, we feel that our strengths are unmatched.
Our corporation’s philosophy is simple – “Commitment to the Client.” We realized that without performance to the client, we would not be in business, plain and simple. Our management style is to develop a partnership with our clients, allowing us to work side by side with our clients as we both grow. As you can see from our answer to previous questions, we care about our employees, and as such, we like to reward them for a job well done. We feel that we can adapt to the changing healthcare environment more easily than our competition. We can be molded to meet the expectations and goals for our clients. This is what sets us apart from our competitors.