MDeverywhere 1
Physician-CentricRevenue Cycle Management Company
Cathy Steadman
Director of Business
Development
MDeverywhere 2
About MDeverywhere
MDeverywhere’s mission is simple – to increase your practice revenue
– Our product is a paid claim
Founded 1995, 500+ EmployeesCurrently Serving:
– 3,200 physicians nationwide– Over 60 different specialties– Group practices, faculty practices, hospital
departments
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Interfaces and Workflow
Register Patients
HOSPITAL SYSTEMHOSPITAL SYSTEM
Web / Handheld Charge Capture
MDEVERYWHERECharge Capture
MDEVERYWHERECharge Capture
ADT InterfaceDemographics
Submit ClaimsPost PaymentsAppeal Denials
Work AR
MDEVERYWHEREBack-Office
MDEVERYWHEREBack-Office
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The MDeverywhere Difference
Eliminate Lost Encounters & Reduce
Days to BillingDecrease Denials by 90%
Enforce Payer Contracts Earn PQRI Bonus
Visibility&
Control
We will increase revenue 5% to 15%
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How We Increase Revenue:1. Rules Engine Reduces Denials 90%
Handheld & web-based charge capture delivering rules at point-of-care– 15 Million pre-defined Payor Specific rules
including:
– Additional rules built based on your denials = System Gets Smarter
• Incorrect Diagnosis Code• Bundling/Unbundling• Missing Modifiers
• PQRI Measures• Invalid Referring Physician• Global Period Edits
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How We Increase Revenue:2. PQRI & E-Prescribing Rules = 4.0% Bonus
Physician Quality Reporting Initiative (PQRI)– Rules engine supports the current PQRI quality
measures
– If a patient is eligible our rules engine automatically enters PQRI procedure codes
– Result: 2.0% Medicare bonus
E-Prescribing rules will earn you the 2.0% Medicare bonus
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How We Increase Revenue:3. Eliminate Lost Charges & Reduce Days to Billing
Actual Client Outcomes
19
3.5
10.4
3.5
02468
101214161820
Pre MDe Post MDe
Day
s to
Bill
ing
Inpatient Outpatient
Reduced Days to BillingEliminate Lost Charges
12%
1.20%
0%
2%
4%
6%
8%
10%
12%
14%
Inpatient Outpatient
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How We Increase Revenue:4. Payor Contract Compliance
Commercial payors underpay claims by 7%– We build a knowledge base with your payor
contracts and payment rules (multiple surgery reduction, etc.)
We know what you are supposed to be paid on every claim
– Appeal every claim where the payment is less than the contracted amount
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Payor Contract ComplianceIdentify Underpayments
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Payor Contract Compliance Appeal All Underpayments
Wisteria Insurance Company 100 Payor Lane, Suite 100 Big City, FL 77777 Regarding:
Patient Name: Jones, Pat Patient ID Number: 333-33-3333 Provider Name: SMITH, HENRY, M.D Date of Service: 01/04/2005 Payor Claim No.: 121123-12345
Dear Sir/Madam:
According to our agreement with Wisteria Insurance Company, the total allowable indicated on the Explanation of Benefits (EOB) for the above referenced claim is incorrect.
Total Expected Allowable: $97.21 Total Actual Allowable: $89.55 Remaining Allowable Due: $7.66
A Comparison of Allowable report is attached that provides additional detailed information regarding this claim, the services rendered and information regarding expected reimbursement by line item. Please review this information and process for appropriate disposition. If the information that I have provided regarding your obligations and reimbursement policies is in error, please provide applicable details to that effect. If it is not, please adjust the allowed amount and remit any additional monies owed. Your Prompt attention is greatly appreciated.
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How We Increase Revenue:5. Referring Physician Communication
Fax sent automatically to referring physician when a patient is admitted to and discharged from the hospital– Customized fax includes patient name,
diagnosis, procedures, admission (discharge) date and attending physician
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Our Web Based Practice Management Software offers Improved Visibility, Transparency and a Streamlined Workflow– Patient Ledgers
– Batch Status
– Patient Accounts Receivable
– Management Reports
Administrative Benefits: Visibility
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Administrative Benefits:Patient Ledger
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Administrative Benefits:Workflow Tracking
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Administrative Benefits:Patient Accounts Receivable
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Administrative Benefits:Management Reports
– Insurance Aging Summary– Insurance Aging Detail– Patient Aging Summary– Patient Aging Detail– Charge, Payment &
Adjustment Summary
– Procedure Analysis– Denial Summary– Denial Detail– Net Collection– Executive Summary– Payor Mix
Web based reports by doctor and department are available to different users based on their access level
MDeverywhere can also create custom reports for your practice
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Net Collection Report: Our Report Card
Charges by date of service
Payments tie back to date
of service
Money we are not allowed to
collect
Professional discount
Bad Debt
Net Collections % = (Payments) / (Charges – Contractual Write-offs – Discretionary Write-offs)
East Hills Medical
Month Orig Chgs Payments % Contract % Discretion % Uncollect % Total W/O % Net Bal % Net % ColNov-08 368,443 184,332 50% 176,554 48% 4,553 1% 2,788 1% 183,895 216 0% 98%Dec-08 370,443 183,887 50% 179,443 48% 2,544 1% 4,332 1% 186,319 237 0% 98%Jan-09 365,998 183,002 50% 175,449 48% 3,322 1% 3,322 1% 182,093 903 0% 98%Feb-09 366,598 181,224 49% 179,334 49% 2,988 1% 1,212 0% 183,534 1,840 1% 98%Mar-09 372,987 185,443 50% 181,229 49% 2331 1% 434 0% 183,994 3,550 1% 98%Apr-09 369,002 183,443 50% 178,443 48% 1239 0% 323 0% 180,005 5,554 2% 97%
May-09 345,098 172,334 50% 165,445 48% 455 0% 0 0% 165900 6,864 2% 96%Jun-09 359,012 171,334 48% 163,221 45% 124 0% 0 0% 163,345 24,333 7% 88%Jul-09 350,114 142,332 41% 153,222 44% 221 0% 0 0% 153443 54,339 16% 72%
Aug-09 344,229 130,445 38% 121,345 35% 0 0% 0 0% 121345 92,439 27% 59%Oct-09 372,998 97,894 26% 92,332 25% 0 0% 0 0% 92332 182,772 49% 35%Nov-09 361,873 11,239 3% 2,398 1% 0 0% 0 0% 2398 348,236 96% 3%
Write-Off
11/30/2009
Net Collection Report
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Denial Summary Report
East Hills Medical
Category / Reason Count Charge Avg Charge % Charge Count Charge Avg Charge % ChargePatient Insurance Benefits
Only Payable 1X Year 0 0 0 0% 0 0 120 0%Terminated Coverage 3 375 125 4% 8 1,008 126 5%Ineligible Dependent 2 274 137 3% 3 414 138 2%Prior/After Effective Date 1 155 155 2% 2 310 155 2%
Total Patient Insurnace Benefits 6 804 417 8% 13 1,732 539 9%
CodingBundled with Other CPT 0 0 0 0% 0 0 0 0%Needs Notes / Report 8 1,152 144 11% 18 2,556 142 13%Invalid CPT Code 0 0 0 0% 0 0 0 0%Invalid / Unrelated ICD 0 0 0 0% 0 0 0 0%Medical Necessity 10 1,200 120 12% 16 1,920 120 10%Service Not Paid Sep / Bundled 0 0 0 0% 0 0 0 0%Missing Modifier 0 0 0 0% 0 0 0 0%
Total Coding 18 2,352 264 23% 34 4,476 262 23%
ContractingOut of Network 0 0 0 0% 2 262 131 1%Hospital only Plan 0 0 0 0% 0 0 0 0%Dr. Not Contracted 0 0 0 0% 1 0 0 0%Dr. Not Certified for Procedrue 0 0 0 0% 0 0 0 0%
Total Contracting 0 0 0 0% 3 262 131 1%
RegistrationMissing Ref Dr UPIN 3 282 94 3% 5 470 94 2%Missing Dr. ID# 0 0 0 0% 0 0 0 0%Insurance can't ID Patient 14 1,778 127 18% 23 2,921 127 15%Covered by Another Payor 18 2,394 133 24% 32 4,256 133 22%Patient Address Invalid 22 2,530 115 25% 43 4,945 115 26%Missing / Invalid Facility 0 0 0 0% 0 0 0 0%
Total Registration 57 6,984 469 69% 103 12,592 469 66%
Total 81 10,140 1,150 100% 153 19,062 1,401 100%
Month Year-To-Date
12/31/2007
Denial Summary Report
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Our Start Up Process
No software license fees No maintenance or support fees No interface, training or conversion fees Deposit equal to one month of service is
refunded to client after start-up We get paid a percent of collection Implementation Time: 8 - 12 weeks