1. Monthly Audit Management for ACCOUNTS RECEIVABLE
2. Evidence based Recalls and performing Diagnostic
Tests/Procedures and Annual Wellness Visits for better patient
care and risk management.
3. Streamlining office workflow with the use of technology and daily
reporting for all administrative tasks. Implementing
accountability at all levels in the practice, improving productivity
and cost optimization.
1. Monthly Audit Management for ACCOUNTS RECEIVABLE (First Step for Revenue Growth up to 10%)
• Streamlining office workflow with the use of EHR and back-office
services for following up OUTSTANDING claims every 6-7 weeks.
This process alone with increase collections by 10% or more
• EHR’s Claim Follow up Management provides a comprehensive
list of claims that are outstanding by PRIMARY payer, Secondary
Payer, and Patients.
• CS’s AR Follow up Team can conduct Monthly Audits for all
claims that need a phone call. Our team would make that call and
add remarks into EHR for future tracking.
• CS would also compile a list of claims that need CORRECTION
and forward it to Billing Team in practice.
• Cost per call is $1.25 compared to $4.00 in office
• Builds up knowledge base for Denials by payers for an active
Denials/Appeals Management.
• Enables team members to finds the status of outstanding claims
and document it with time/date and reference #.
• Question Insurance companies’ rep if previous (last) call status
and current (this) call status is identical for that particular claim,
as this indicates that no further action was taken on the claim.
• Ensures competency as the AR teams are familiar with all
medical policy and guidelines for claims.
• Team Members question payers if protocols regarding following
clean claim act (OR) Adjudicating claim, as per company’s claim
adjudication policy, are not followed.
1. Monthly Audit Management (continued)
2. Evidence based Recalls
Performing Clinically Necessary Tests/Procedures
Annual Wellness Program
PRE-VISIT PREPARATIONS
Working on Clinical Decision before Patient’s Arrival
TO BE COMPLETED BY THE CLINICAL TEAM, 24 HOURS IN
ADVANCE OF PATIENT’S VISIT
• Look at Problem List
• Last Test and Procedures
• Last Lab Results
• Last Annual Well Visit
• Identify Plan of Care
• Make a List of Clinically Necessary Procedures Based
on Current Problem list and Previous Assessment.
CS’s back-office physicians panel can help you with above process.
PNO Name CPT CPT Description Last performed Due Date ICD code
329 Wertz, Alfred 93000 ELECTROCARDIOGRAM 5/10/2010 10/25/2013 401.1,443.9,786.51,V72.84
93922
Noninvasive physiologic studies of upper or lower extremity arteries, single level, bilateral 5/10/2010 10/25/2013 443.9
SUGGESTED 78452
Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection 786.51
93224 HOLTER ANALYSIS 786.51
93306 Echocardiography 786.51
2. Evidence based Recalls
Performing Clinically Necessary Tests/Procedures
Annual Wellness Program
Patient Name : Wilfred October
Insurance : BCBS
Active Problems : PVD, Chest Pain, Hypertension, SOB
Recommended Primary Diagnostic Procedures for Risk Management
EKG, PFT, ABI
Yearly Annual Wellcare Covered and Recommended
Based on 24 Hours or 48 Hours CHART PREPARATION
EKG last done on 05/10/2010 and ABI last done 05/10/2010 and PFT never
done. Patient didn’t have Annual Wellcare Visit as well.
Plan of Care : Recommended EKG + PFT + ABI
To be scheduled : Annual Well Visit
Check InsuranceCheck Registration
(Including Address &
Phone Numbers)
Collect Co-pay
Schedule appointment Upon Check out (OR)
depending Upon Clinical Alerts
Keeps patients ready for Pre-Exam
(OR) Triage post above functions
Ask For balance, Co-Insurance &
Deductible
3. Streamline Office Workflow through Technology and Back-office Team members.
Receptionist’s CHECKLIST
• Verify the date & time of last office visit.
• Makes Sure that Demographic Information is up to date.
• Address any system Alerts for Financial/Insurance Issues.
• Collects patient balances due to co-Insurance/Co-pay (OR)
Deductible
• Review any Alerts for clinical reasons, such as preventive test (OR)
recall based on conditions and previous treatments (OR)
Procedures.
• Distribute Pre-Visit and/or Medical Necessity Questionnaire for
Diagnostic Tests and Procedures
• If Patient was ordered an outside Test/Procedure/Referral, were
those completed and are reports available?
• Appointment Scheduling upon patient’s check-out
3. Streamline Office Workflow (continued)
3. Streamline Office Workflow (continued)
Make a comprehensive list of all OPERATIONS by
department that can be potentially streamlined using
AUTOMATION OR BACK-OFFICE team at $6.5/Hour.
Front Desk
No Show Rescheduling
-EHR’s Automated Engine can set-up calls / text messages / email
notification for No Show Rescheduling.
-CS Team can call all patients that didn’t show up and schedule
them in EHR so that there is no opportunity loss.
Precertification / Prior Authorization / Referral
-CS Precert Team can obtain Precert/Authorization /Referral for
various office based Procedures at $6.5/Hour instead of $16-
18/Hour. Our team can request Medical Records if necessary or
bring your clinical team on 3-Way Conference call as needed.
3. Make a comprehensive list of all OPERATIONS by
department that can be potentially streamlined using back-
office team at $6.5/Hour.
Front Desk
Eligibility
-EHR’s Direct B2B Connection can check upto 70% of Eligibility
-CS Team can provide Eligibility Services for remaining 30%
patients that need a Representative Call.
So combined HYBRID service can provide 100% verification for all
patients.
Appointment Confirmation
-EHR’s Automated Engine can schedule calls / text messages /
email notification for Appointment Confirmation.
-CS Team can provide appointment confirmation
for those HIGH VALUE PROCEDURES through
Representative Calls.
3. Make a comprehensive list of all OPERATIONS by
department that can be potentially streamlined using back-
office team at $6.5/Hour.
Medical Records
Scanning/Indexing Services
-EHR’s Document Management Module allows you to route IN
BOUND FAXES or Scanned Images to correct patients’ chart
however that process of INDEXING could be time consuming for
practice. Indexing process can be simplified with CS back-office
team and reduce cost of indexing by 40% or more.
Average cost of Indexing per page / file while done with OFFICE
SECRETARIES is 50 cents whereas same level of accurate services
done with CS’s back-office team would cost practice around
10 to 25 cents per image / file.