The Perfect Revenue Cycle

Presenter: Fred Melroy

Good Billing Is Just Process

• Great Book is Check List Manifesto by Atul Gawande, MD.

• Good Billing is Like Good Surgery or Any Activity in Life that Requires Organization!

• Life and Billing is Complicated but Steps in an Organized Manner Make it Easy.

• Someone Asked Why We Keep Track of All Scheduled Patients.

• Create an easily accessed, integrated, web-based EHR system specifically designed to address the needs of your practice and the demands of the practitioner.

• Use technology to develop an electronic “medical home”.

Reduce errors. Improve quality and safety. Increase revenue. Create performance measurement tools. Increase patient education. Enhance communication among service providers. Commercial Billing vendors.

• Try and meet all of these complex needs in one, comprehensive EHR solution and avoid the excess cost and lack of continuity associated with multiple technology

Create a Process

The Dilemma

Patient Scheduling

Patient Demo Entry & Eligibility Verification

Medical Necessity Edits

Medical Necessity Edits

Claims Scrubbing

Paper & Electronic Remittance

Denied ClaimsCompliance System

Claims Management

EMR/EHR

Registration System

Distributed environment lead towards inefficient, complex system results in increased operating cost and important of all LOST REVENUE

The Revenue Cycle: Critical Billing Tasks

CureMD - Integrated All-in-One Solution

CureMDEMR

PMS & RCM

Registration & Scheduling

Clean Claim & medical

necessity Edits

Denial Management

Patient Scheduling

Patient demo entry & Eligibility Verification

Medical Necessity Edits

Claims scrubbing

Paper & Electronic Remittance

Denied Claims

What makes us stand apart in billing?

• One system that ensures integrated clinical and improved communication for the complete revenue cycle management.

• All in one solution that works with your existing billing and financial system ensuring:

i. HIPAA Compliance

ii. Efficiency improvement

iii. Maximum effectiveness

iv. Ensuring clean claims for denials prevention

v. State of the art rejection and denial management

vi. Reports that make sense and Monitor activity.

Poor Revenue Cycle Management

• Under coding caused by the chilling effect of coding challenges5-10% Lost

• Services provided and not billed5-7% Lost

• Timely filing denials6-15% Lost

• 50% of rejections not resubmitted5-15% Lost

• 50% of denials not appealed (70% of appealed successful)3-7% Lost

• Payments less than fee schedule not identified or challenged6% Lost

• Post payment recoveries not challenged2%+ Lost

More Income is Lost in Poor RCM Than You Can Achieve in Rate Increases

Why Outsource Billing?

• Straight 60 % reductions in operational and administrative cost in comparison to in-house billing

• Staying up to date with financial health of your practice by having access to multiple financial reports (24/7) in comparison to manual in-house reporting

• Losing 2% of total Medicare revenue on e-prescribing and PQRS incentives

• Losing 17% of all claims denied for timely filing, caused by delays in the billing (Source AMA)

• Efficient Denial Management enables you to track denied claims and what is being or can be done to get them paid. (MGMA reports that 7%-14% of all claims are denied because of easily correctable in–office errors)

It’s More Than Just Time

• You still need to document the visit!• Does you System Check Codes or Prompt Needed Items.• Codes 99201-99215 should be used depending on the

complexity of the visit• For level 5 make sure the history meets the definition of

comprehensive.• A new patient is a patient who has not received any

professional services (face to face) in the last three years.• This time includes those you see for a different Dx.

What is a Medicare Consult?

• “conventional medical practice is physicians making a referral and physicians accepting a referral will document the request in the patients record”.

• The results of the referral must be communicated.• For in hospital cases the principle physician of record will

append modifier “AI” on codes. Coordinate with Hospitalist!

• If physician is requested to see a patient in the ED, the emergency visit code should be used unless patient is admitted and then initial hospital care code should be used.

How do you Bill?

• If the service is secondary to a primary service must use modifier 25 on the primary service.

• Smoking cessation requires a separate diagnosis code as does nutritional counseling.

• You don’t have to be a PCP but annual visits are limited by type, smoking for example is 8.

• Make sure you are familiar with the coding instructions and as a guideline CMS for the first time has published time indicators. For example: 99213=15 minutes, 99214=25, 99215 =40 minutes, 99204 = 45 minutes.

• Don’t forget the “AI” for your admitted patients.

Make Sure to Use the Right Codes

Manhattan Allowable

• Initial Wellness = G0402 $169• EKG’s (no waiver) G0403-G0405 (G0403 price) $24• Annual Wellness = G0438 & G0439 $186 & $125• Ultrasound for aneurysm = G0389 $137• Medical Nutritional Therapy = 97802- 97803 $34 & $30• Medical Nutritional Therapy Group = 97804 $28• Medical Nutrition Therapy Additional = G0270 $32• Medical Nutrition Therapy add on Group = G0271 $16• Screening Pelvic Exam = G0101 $43

Financial Reports

CureMD’s 24/7 access to different reports helps to stay updated with your practices financial health

Some Numbers That Matter!• Average collection ratio for existing CureMD

Clients94.8%

• Customer retention rate97%

• A/R over 90 days3%

• Average Medicaid turnaround time14 days

• Average Medicare turnaround time15 days

• Average Commercial turnaround time18 days

• Dedicated Billing ManagerThere for You

CureMD Healthcare55 Broad Street, New York, NY 10004 Ph: 212.509.6200www.curemd.com

Thank you