Billing and Revenue Cycle Management Services

An essential component of Best Practices’ service is helping the practice evaluate procedural and diagnostic coding issues. Best Practices’ team of certified professional coders uses specialized coding software to assist in the selection of appropriate CPT and ICD-9 codes. Best Practices’ coding background also entails correct use of CPT modifiers, required and recognized by all third-party carriers to assist with determining of appropriate allowances. Additionally, Best Practices provides on-going physician and staff training and education in appropriate Evaluation and Management Coding, Surgical Coding and medical record/operative report documentation. This helps position Best Practices’ clients to successfully withstand any government or payer audit.

Best Practices will develop front-end controls and design information flow systems to ensure timely and accurate data capture of all patient demographic, insurance, and charge information, preventing lost revenues. Whenever possible, Best Practices and its’ partners will develop system interfaces to electronically transfer patient demographic and charge information directly into our billing and reporting system. Best Practices will review and enhance your existing charge and registration documents, customized to your practice’s needs and specifications.

• Best Practices will provide staff education and training in the areas of insurance pre-certification, preauthorization and predetermination processes.
• Pre-certification involves establishing approval to perform a specific procedure based upon medical necessity. Benefits will be issued in conjunction with the insurance policyholder’s contract provisions and/or limitations.
• The preauthorization process is conducted to determine if a service to be performed is a covered benefit under the subscriber’s insurance plan. Preauthorization assists the practice with informing patients of associated out-of-pocket expenses and allowances for the service.
• Predetermination provides the practice with information regarding the allowed amount or payment amount for a particular service. Predetermination does not usually take into consideration patient deductibles or co-payment amounts due.
• Pertinent financial and billing information obtained through these pre-billing processes is useful, not only with increasing patient awareness of financial obligations, but provides the basis for efficient claim submission and benefit processing.

Best Practices will review your practice’s current charges and compare them to the practice’s managed care contracted fee schedules, state-specific Medicare Locality Fee Schedule, and against MediCode’s Fee Analyzer of regional Fee Averages. This will assist with determining appropriate charges. With your approval, Best Practices will implement any proposed fee recommendations. Best Practices will then monitor Explanation of Benefit Forms to assure that your fees are consistent and established within Usual, Customary, and Reasonable (UCR) charge standards.

To maximize cash flow and expedite reimbursement, Best Practices electronically submits insurance claims to third-party carriers. Paper claims with required supporting documentation are generated promptly and mailed to all responsible third-parties when applicable. In addition, Best Practices will utilize pre-billing claim scrubbing and editing software to eliminate unnecessary claim denials by generating “clean” claims for initial claim transmission.

Best Practices establishes reimbursement criteria by payer financial class in accordance with industry standards. Each explanation of benefit form is reviewed to detect inappropriate denials. Payments erroneously denied are appealed for additional allowances.

Integral parts of Best Practices’ service are fundamental accounts receivable and revenue cycle management processes with thorough follow-up protocols. Best Practices’ proactive approach includes conducting telephone tracers and providing written communication to third-party carriers on delinquent outstanding balances. This process begins thirty days after claim submission and continues until reimbursement or claim adjudication is complete.

We send your patients and other responsible parties an itemized monthly statement reflecting detailed account activity of all charges, payments, and adjustments.

Payment arrangements are scheduled for outstanding patient balances after third-party consideration has been finalized.

When all avenues have been exhausted in pursuit of payment, an account disposition form is forwarded to your practice for appropriate direction. Best Practices will not refer any patient to an outside collection agency without prior, written case-by-case approval.

To provide the highest level of fiscal security, Best Practices recommends the use of a bank lockbox service. This allows for the immediate deposit of payments into The Federal Reserve System and simultaneously, into the practice’s personal account. Best Practices will assist the practice in establishing the lockbox at the bank of their choice. We will arrange with the bank, daily receipt reporting along with forwarding of payment copies and original EOB’s to Best Practices so as to complete the accounting process.

Best Practices will provide to the practice financial reports each month. We use GE Medical Systems’ Centricity® Physician Office practice management system. Centricity’s advanced reporting capabilities summarize and track the practice’s charge, payment, and adjustment activity. Payments can be applied against either specific charges or to the oldest outstanding unpaid service. Aged accounts receivable reports are standard to the software program. In addition, Centricity® also provides a high level of financial analysis from a number of perspectives including reimbursement studies by payer, location and various categories such as procedure code. Centricity® also has the capability of producing daily and monthly Financial Report Summaries, along with reports that list the productivity of each group of procedures for a selected carrier, plan, physician and data range. This application is extremely valuable to the practice since it provides the information necessary to analyze third-party reimbursement by carrier. Additionally, it provides the means to not only detect and appeal under- payments and denials, but can also assist the practice with setting fees, pricing, and contract negotiations.

Best Practices can create customized reports that present specific data elements. These reports can deliver information from the database in almost any format the practice desires. Depending on the complexity of the report, programming fees may apply.

Best Practices Senior Management will meet on a monthly or quarterly basis with physicians and appointed administrative staff to discuss the fiscal health of the practice and to address any practice related issues. These meetings are designed to exchange vital information. This provides the necessary tools to assist the practice in making informed business decisions regarding the future direction and development of the practice.

For those practices that have invested in an in-house computer system or only require “short-term” assistance to enhance or improve current business operations, Best Practices offers a consulting service program. Consulting clients will be selected diligently, and on the justification of existing computer investment and practice circumstances.

Through a strategic partnership with Quatris Health, Best Practices is able to offer clients GE’s Centricity® Physician Office Practice Management system.Quatris, an application service provider (ASP), hosts the application on their systems. Your staff runs the application from a secure link on their computers. Quatris’ ASP hosting is fully compliant with HIPPA and SOX. You get the benefits of the application without the expense of maintaining your own computers and information technology support staff. This simple, on-line portal provides secure access to patient and financial information.